WHO Director-General addresses health officials in the Western Pacific

Dr Margaret Chan
Director-General of the World Health Organization

Keynote address to the Regional Committee for the Western Pacific, Sixty-third session
Hanoi, Viet Nam

24 September 2012

Mr Chairman, Excellencies, honourable ministers, distinguished delegates, Dr Shin, ladies and gentlemen,

This region has brought the world some very good news.

In 2003, you resolved to eliminate measles and control hepatitis B, and to use activities for achieving these goals to strengthen routine immunization services.

Your countries have made tremendous progress in reducing hepatitis B infection rates in children to below 2%. Even more ambitious goals have been recommended for 2017.

The drop in measles has been breath-taking: only two measles deaths reported this year, representing a 99% decline since 2003. The measles initiative is also being used to accelerate the control of rubella and the prevention of congenital rubella syndrome.

Wealthy countries in this region have provided models for success in other well-off countries well beyond the region. China has shown the impact of intensified immunization activities on a massive scale. Smaller, less-privileged countries tell us that the hard-to-reach really can be reached when a government is determined.

The Western Pacific is on the verge of becoming the second WHO region, after the Americas, to be certified measles-free. During this session, you will be looking at draft guidelines for the verification of measles elimination. You are doing this job very carefully as well.

In public health, everyone loves to hear about success, about jobs well done.

You are pushing ahead with control of the neglected tropical diseases. You will be considering a detailed action plan for seven priority NTDs. These diseases affect the poorest of the poor. But even in the midst of dire poverty, much of the disease burden can be controlled at a low cost, even before poverty itself is reduced.

This turns the tables. In their long history, these ancient diseases gradually disappeared from large parts of the world as incomes rose and standards of living improved. Your action plan shows how, with good medicines and streamlined strategies, these diseases can be brought to their knees, actually contributing to poverty alleviation on a massive scale. This is one reason why your Regional Director, Dr Shin, has made NTDs a priority for the region.

At the same time, you are not shying away from the operational, financial, and political challenges that face the control of NTDs in this region. With your eyes wide open to the problems, I am confident that, in this case, too, you will prove that the hard-to-reach really can be reached.

I also welcome the attention you are giving to malaria. At the end of next month, Australia will be hosting a major conference on malaria aimed at saving lives in Asia and the Pacific. This is a technical meeting, looking at prospects for control and elimination and at problems and challenges, including the significant global threat of artemisinin resistance.

But this is also a political meeting, promoting political as well as technical leadership and looking for ways to ensure sustainable financing, also for the containment of artemisinin resistance.

Considering what is on the horizon, any disease that we can eradicate, eliminate, or get under tight control frees resources for tackling the next big challenges.

The relentless rise of chronic noncommunicable disease is among the biggest of these challenges. Meeting this challenge requires new ways of thinking and working. The response, especially concerning prevention, depends heavily on the ability of health officials to persuade other sectors to include health concerns in their policies.

This is a problem that I see, personally, time and time again: the lack of policy coherence within governments, the tendency of the various ministries to stick to strict and narrow mandates.

This kind of compartmentalized thinking loses some of its relevance in a world of radically increased interdependence among countries, but also among sectors. The distinctions between policy spheres have become blurred. What is the net gain if a minister of trade approves an agreement in the interest of national prosperity that ends up flooding the market with tobacco or other unhealthy products?

We talk a great deal about whole-of-government and whole-of-society approaches to health. We know that the health sector, acting on its own, will never be able to counter the rise of noncommunicable diseases or tackle problems like road safety, the prevention of violence and injuries, or improvements in the nutritional status of populations.

Activities surrounding implementation of the WHO Framework Convention on Tobacco Control show us how this kind of multisectoral action actually works in practice, how it can be made to happen.

In July, the Philippines hosted a regional consultation on tobacco and trade. Some of the measures in the Framework Convention have implications on trade and investment, making closer collaboration between the health and trade sectors critical to achieving shared goals for economic development and a healthy and productive population.

That consultation brought ministries of trade together with their counterparts in health. It presented evidence showing how the tobacco industry is exploiting international trade and investment agreements, and why and how governments can fight back. The consultation showed how joined up action between health and trade ministries can protect populations from a deadly product and spare governments the related, and enormous, costs.

Once again, let me commend Australia for standing up to the tobacco industry, and winning, on the issue of mandatory plain packaging for tobacco products. We hoped for a domino effect in which the good guys start winning. We were all pleased when, earlier this month, a Norwegian court upheld a ban on displaying tobacco products in stores. Norway now plans to follow Australia by requiring plain packaging of tobacco products.

The tobacco industry is not at all pleased, and this pleases me enormously.

The Western Pacific was the first WHO region to have articulated a measurable target for reducing tobacco use. You have before you a report that asks whether countries in this region can, by 2014, reduce the prevalence of tobacco use by 10% by 2014.

You can and you must. Without question, full implementation of the WHO Framework Convention on Tobacco Control would deal the greatest single preventive blow to noncommunicable diseases.

Let me thank the Republic of Korea for hosting the Fifth Session of the Conference of the Parties to the WHO Framework Convention, to be held in Seoul in mid-November.

Every country in this region is a party to the Framework Convention. I urge you to keep giving the world uplifting stories where the good guys win.

Ladies and gentlemen,

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

The target date for reaching the Millennium Development Goals 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 procedures aimed at collecting a broad range of views.

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, and feasible.

The MDGs 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.

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

We can all 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.

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, alleviating poverty, and relieving vast human misery.

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

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 noncommunicable diseases.

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 concept that public health has to offer. It is the best way to cement the gains made during the previous decade. It is a powerful social equalizer, and it is the ultimate expression of fairness.

It is a unifying concept that puts in place, in a coherent and logical way, the many pieces in the jigsaw puzzle of factors that, together, ultimately determine health outcomes.

It is the route towards two of the most treasured goals in public health: greater fairness in access to care, and greater efficiency in the delivery of services. Traditional economic thinking tells us that you cannot have both. There must be a trade-off between the goals of equity and efficiency. Experience in public health tells us otherwise.

When countries move towards universal coverage, the benefits of interventions, when taken to scale, are value-added. They not only protect health or prevent a disease. They bring down the risks for entire populations.

When coverage levels are high, say, for AIDS, malaria, or tuberculosis interventions, disease transmission goes down, thus amplifying the impact of interventions and improving their efficiency. As another example, high vaccine coverage produces herd immunity, so that even those who have not been immunized benefit from population-wide interventions.

In addition, economists point to tremendous economies of scale in service provision when interventions reach a large proportion of the population.

I was extremely pleased to learn that the Government of Viet Nam has organized a side event later today on universal health coverage.

This week, I am attending a number of high-level health-related events at the United Nations General Assembly. One of these events will launch the Lancet’s series of research papers and editorial perspectives on universal health coverage.

The Lancet papers published to date present evidence showing the positive impact of universal coverage on health outcomes. They explore the transition to universal coverage in its political and economic dimensions, and offer lessons about how health financing reforms have been enacted in a number of lower income countries.

Editorial comments offer a big-picture view of the historical significance of this evidence. One of these comments suggests that the global movement towards universal coverage may be the third great transition in health, following the demographic transition that began in the late 18th century and the epidemiological transition that began in the 20th century and eventually saw noncommunicable diseases overshadow infectious diseases in every corner of the world.

In the Lancet series, it is extremely helpful to have a respected economist, like Jeffrey Sachs, argue strongly against what he calls “lazy thinking”. This thinking assumes that user fees will reduce overconsumption of health services or increase their value in the users’ eyes. Not true. User fees punish the poor.

You will be considering a report on progress in implementing the region’s health financing strategy. This strategy contributes to universal coverage as the vision of national health system development in the Western Pacific.

As you are aware, health financing reforms are just one part of the picture. Health insurance raises public expectations. People expect ready access to medicines and services, and they want quality. A commitment to universal coverage means meeting these expectations as well.

Don’t punish the poor, but don’t disappoint them either.

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.

Thank you.