Director-General's Office

Launch of the DCP3 Series with The Lancet

Dr Tedros Adhanom Ghebreyesus' remarks on the launch of the DCP3 Series with The Lancet

6 December 2017

Good morning ladies and gentlemen,

Thank you, Richard, for the introduction, and for the invitation to be here today. It’s a pleasure to be with you for the launch of this important contribution to global health.

I would like to congratulate Dean Jamison and his team at the University of California, San Francisco for the excellent work they have done on this third edition of Disease Control Priorities.

And I would like to thank the World Bank and the Bill & Melinda Gates Foundation for their investment in this project.

WHO is pleased to have played a part in the development of DCP3, with its focus on universal health coverage.

As you know, universal health coverage is my top priority, and is central to WHO’s mandate.

Our new 5-year strategic plan sets an ambitious target to see 1 billion more people with health coverage by 2023.

It is encouraging to see the political momentum that is building to make UHC a reality in all countries.

The inclusion of UHC as target 3.8 in the Sustainable Development Goals has given new impetus to the movement.

Next week’s UHC Forum in Tokyo will be a valuable opportunity to build on that momentum.

Together with our partners at the World Bank, we will be launching a Global Monitoring Report that provides new data on the number of people who lack access to essential health services, and who are exposed to financial hardship as a result of health spending.

Without giving the game away, those data show that we have a lot of hard work to do.

DCP3 complements the Global Monitoring Report perfectly.

Because achieving UHC requires both strong political commitment and technical expertise.

Neither on its own is enough. Technical expertise without political commitment is like a great book that sits on the shelf gathering dust.

But political commitment without technical expertise is empty rhetoric that changes nothing.

That’s why this report is so welcome.

It builds the evidence base for setting priorities and making informed decisions that make a real difference.

And it gives me a tool that I can use to persuade heads of state, heads of government and ministers that investing in UHC is not only achievable and affordable.

I am particularly pleased that DCP3 goes beyond modelling standard metrics such as quality-adjusted life years to include measures of financial risk protection.

In my view, out-of-pocket health spending is one of the most important indicators of progress towards UHC.

While it is vital to ensure that health services are available and of high-quality, if people cannot afford them, they will not use them.

Indeed, the indicators for UHC in the SDGs are those that measure the level of household health spending as a proportion of income.

I also welcome the attention given in DCP3 to health promotion and disease prevention.

Universal health coverage is not only about treating the sick. It’s also about protecting the healthy.

The most cost-effective investments are in population-level services that keep people out of care, such as road bumps, motorcycle helmets, smoking regulations and measures to promote breastfeeding.

By contrast, the most expensive services are often those that have the least benefit, such as tertiary care in referral hospitals.

Those services are of course important, and must be provided. But the point is that countries that invest in promoting health and preventing disease will make considerable savings further down the continuum of care.

This is not just good health care; it’s good economics. With ageing populations and the increasing burden of noncommunicable diseases, the most sustainable health systems will be those that invest most heavily in ensuring that people stay out of hospitals.

Prevention is not just better than cure; it’s often cheaper.

Of course, no country can afford to provide every conceivable health service free of charge to everyone who wants it. That is not what universal health coverage means.

Priorities must be set and choices made about the best use of finite resources.

In that regard, DCP3 makes a helpful distinction between the highest priority package of interventions and a more comprehensive set of services called “essential universal health coverage”.

Some interventions, such as stricter food labelling, cost little to implement but can lead to large health gains for entire populations.

Other measures, such as taxing tobacco, sugary drinks and carbon emissions, and eliminating subsidies on fossil fuels, actually generate revenue that can be reinvested in building stronger health systems.

This may seem like a no-brainer, but it takes political courage to stand up against powerful multinationals.

But apart from the tobacco industry, our relationships with the private sector need not always be adversarial. For example, through constructive engagement with the food and energy sectors, there are opportunities to win major health gains.

This report also makes the point that improving health is not, and cannot, be a job just for health ministries.

It requires coordinated action across every sector of government, including finance, labor, transport, commerce, environment, agriculture and others.

But intersectoral action is much easier said than done.

There is no textbook. There is no one right way. It requires working with countries on a case-by-case basis, taking into account the political, social and economic contexts, and tailoring solutions.

This is what WHO’s country cooperation strategies are designed to do. They are the framework for how we engage with each country. The best country cooperation strategies are explicitly designed to foster intersectoral work.

DCP3 is especially valuable in this regard. By identifying 71 intersectoral policies – 29 of which should be adopted as early as possible – you are giving agencies such as WHO the resources we need for meaningful policy dialogue with countries.

And crucially, this report confirms that far from being a luxury that only rich countries can afford, all countries at all income levels can make progress towards UHC.

This was the conclusion of a WHO study published in the Lancet Global Health in July, which showed that in 67 low- and middle-income countries that account for 75% of the world’s population, 85% of the costs of achieving the SDG health targets can be met from domestic resources.

Those investments would prevent 97 million premature deaths globally by 2030 and add as much as 8.4 years to life expectancy in some countries.

A handful of countries will continue to need external assistance, but for many countries, UHC is an affordable dream.

That’s why I say that ultimately UHC is a political choice.

As I mentioned earlier, the smartest investments countries can make are those that prevent or delay people from turning up in hospitals, where the costs are greatest, and the outcomes are often the poorest.

Almost 40 years on from the Alma Ata Declaration, people-centred primary care remains the bedrock of health systems, and the key to achieving universal health coverage.

But to provide primary care, we must ensure that all people have equitable access to health workers.

This will take political and financial commitment.

Our analysis shows that almost half of the resources needed for achieving the health targets in the Sustainable Development Goals are related to the education and employment of health workers.

Ageing populations and increasing rates of non-communicable diseases are projected to generate demand for 40 million new health workers worldwide by 2030, which would represent a doubling of the current global health workforce.

But most of those jobs will be created in the wealthiest countries. Without action there will be a shortfall, primarily in low- and lower-middle-income countries, of 18 million health workers needed to achieve and sustain universal health coverage.

Ultimately, these are not costs but investments.

Countries that invest in their health workforce create jobs, drive economic growth and increase productivity by getting sick people out of care and back to work.

And because seven out of 10 health workers globally are female, jobs for health workers are jobs for women.

The good news is that there are plenty of great examples of countries at all income levels who have made giant strides both in improving access to health services, and in making those services affordable for their people.

Take China. In the past 20 years, China has made large investments in its health infrastructure, making health services more equally accessible to its vast population. The result has been large declines in child and maternal mortality, improved health outcomes, and increased life expectancy.

In Rwanda, health system reforms over the past 15 years, including the provision of preventive services free of charge to the entire population, have also meant that more mothers survive childbirth, and more children get to celebrate their fifth birthdays. Rwanda’s Community-Based Health Insurance Scheme covers more than 80% of the population, in a country where 90% of people work in the informal sector.

Ladies and gentlemen,

My key message is one of thanks. You have given us a rich resource for global health.

Of course, we all understand the value of models such as this one, and their limitations.

But the greatest limitation is not the model itself. It is us.

Those of us who work in public health must now take these findings, together with the real-world lessons we learn from countries such as China and Rwanda, and use them to cataylse new political commitment in every country.

Thank you.