Excellencies,
Colleagues,
Ladies and gentlemen,
The past fifty years have done more to improve human health than any other period we
know of. There have been vast technological improvements and scientific breakthroughs.
Vaccines have freed the world from smallpox and eliminated polio from the American
continent. Global eradication of polio should be completed by the end of next year and we
are also making encouraging progress in the control of measles and neonatal tetanus. About
80 per cent of the 150 million children born each year are being immunized with the
main childhood vaccines. Global average life expectancy is about 66 years today, while it
was 46 only fifty years ago.
Such figures give an idea of global health trends. They must be further analysed,
however, for a better understanding of the health determinants involved and how they
interact. It is useful to know that there has been a general increase in women's life
expectancy together with improvements in income. But we also know that even at comparable
levels of income, women's life expectancy today is about 25 years more than what it was in
1900.
WHO is a knowledge based organization. For more than fifty years we have been
delivering a public good - knowledge about health and diseases - knowledge about health
science - and knowledge about the success and failure of health sectors.
WHO is also a value based organization. The core value for WHO is to promote equity and
every person's right to lead a healthy life. It is no coincidence that WHO was
created the same year as the Universal Declaration for Human Rights was adopted. The
universal message runs through our Constitution and our mandate.
Our focus on equity leads us to place a special focus on the poor. As we leave a
century of unprecedented human health progress, we can also count that one-fifth of
humanity has no access to health services and that one half lacks regular access to
essential drugs. Inequalities are widening in the developed as well as the developing
world.
When the World Commission on Environment and Development presented Our Common Future in
1987 this was a key message: Poverty is itself a prime source of environmental
degradation. We will not achieve sustainable development for the world until we manage to
reverse the trends of increasing and persisting poverty. We need transfer of knowledge and
technology. We need transfer of experiences.
The same goes for health. Ill-health leads to poverty and the equation works both ways
- poverty breeds ill-health. Taking populations out of poverty is taking populations onto
roads of human, social and economic development.
The developed countries have pledged to contribute to halve the number of people living
in poverty by 2015. That goal is within reach if we make the right decisions in time. For
most of the unfinished health agenda of this century we have the tools and technology to
make a difference. The world has the knowledge and the technology to combat poverty.
I have made it the priority for WHO to pursue the health component of that strategy. We
need to place health at the core of the human development agenda. We will need the
tremendous force of human knowledge and science to achieve that goal. The developing world
carries 90 per cent of the disease burden, yet poorer countries benefit from only 10 per
cent of the resources that go to health. That has to change.
Science and knowledge have provided us with a clear understanding of the health
challenges ahead of us. We have studied the Global Burden of Disease into the next
century. Looking ahead - what are the causes of not only mortality but also disability -
and how can we fight them?
The leading causes of mortality or disability in 1995 show the traditional three on
top: lung diseases, diarrhoea, and perinatal conditions, the same three that would have
been on top had we done this study back in 1965 or even earlier.
All of them can be effectively fought. What about the leading risk factors? First,
there is malnutrition. Then follows poor water and sanitation. And then comes unsafe
sexual behaviour - largely linked to the spread of HIV/AIDS.
Looking towards 2020 there are major changes ahead - due to an ageing population - and
economic and social transition. The three leading causes of mortality and disability in
2020 are likely to be heart disease, mental depression and road accidents - unless there
are new and new unpleasant surprises from the spread of communicable diseases.
And what about the leading risk factors? Many are the ones as we know them today. But
our studies - and that of others - show one remarkable shift. That is the dramatically
increasing role of tobacco. By 2020 the burden of disease due to tobacco is
expected to outweigh that caused by any single disease. From its 1990 level of being
responsible for 2.6 per cent of all disease burden worldwide, tobacco is expected to
increase its share to close to 10 per cent. These are the dry facts.
We know the challenges. And we also know about the main factors contributing to health
gains:
- increases in average income levels which in turn improves health and nutritional status;
- improvements in average educational levels;
- and lastly, the generation and application of new knowledge.
In the final analysis, it is knowledge that appears as the decisive causative factor in
the health revolution of this century. Knowledge is central to the invention and use of
technologies for specific needs and environments. Knowledge is essential for adopting
changes in behaviour that are conducive to health. And knowledge is an international
public good which should be fostered and protected as such.
This is made even more dramatically clear by the revolution that current advances in
information technology and genetics are preparing for the twenty-first century.
It is WHO's responsibility to help our Member States and other partners assess health
needs, and decide how to meet them. We must find out where the knowledge gaps are,
mobilize research to fill those gaps and develop the products required.
To strengthen our analytical capacity, we have set up a new cluster of activities under
the title of "Evidence and Information for Policy". It generates knowledge on
global epidemiological trends, health priorities, policy options, and health interventions
and outcomes. The data used for this come from countries and other WHO departments working
in areas such as human reproduction, diabetes, human genetics, environmental and
occupational health, infectious diseases, mental health, biologicals and vaccines.
These departments are at the forefront of disease control and surveillance. They are
directly associated with the definition and clinical validation of technical standards,
and are in touch both with cutting-edge research and with health care clinics in
developing countries.
They make the link - between Life Sciences and health care; between funders,
researchers, and users; and between new scientific breakthroughs and their applications
for disease control and prevention.
The next step for us is to help validate and incorporate knowledge into best practices.
We do this in close coordination with countries who are ready to apply new tools and
approaches in their public policies and health interventions.
To play its role forcefully, WHO needs to be more proactive in communicating
information to researchers on actual public health needs for research and development; and
to ensure that their findings get to those who need them most.
As we gather this knowledge we need to help transform it into effective and affordable
tools for use by the health systems, especially of poor countries.
Immunization saves about 3 million lives a year, yet about 1.65 million people still
die from vaccine-preventable diseases. Single-dose and multipurpose vaccines would
simplify logistics considerably, thus increasing coverage and reducing cost. In
tuberculosis control, the development of mass miniature radiography for active
case-finding, a single-contact treatment or a new vaccine, would have a tremendous impact
on morbidity and mortality.
New techniques, including recombinant DNA technology, open up exciting prospects for
developing a range of new vaccines. A hepatitis B vaccine has been in use for more than a
decade, but it is only now becoming widely available outside rich countries. We need to
find ways to shorten such periods of exclusivity.
There are complex technological and economic challenges linked to the process of
innovation. Research is costly and innovation will not be driven unless there is a
reasonable return on investment. But while the markets are good at allocating resources in
some contexts, they fail to do so in others. The mere fact that hundreds of millions are
without access to what WHO determines as essential drugs is a clear illustration. Let me
put it in business terms - it is not only devastating for people - it is also bad for
business as there are no markets to explore.
A new look at private-public partnerships may take us a step forward. In WHO we have
initiated a close dialogue with the pharmaceutical industry to identify the obstacles we
face to secure access by all. We have included the private sector in major new initiatives
such as Roll Back Malaria and the Tobacco Free Initiative. Together with the World Bank,
UNICEF, other private partners and industry we are exploring a giant leap forward towards
making the technological breakthroughs in immunization available to groups who normally
would have been denied access.
We need this broad dialogue, and I believe there is a new climate emerging to pursue
it. Technological innovation is a prerequisite, but is only part of the solution. Pricing
and marketing strategies are also needed. These in their turn require supportive
legislation and a regulatory framework to ensure quality control, protection of rights and
the elimination of counterfeit drugs. WHO's work in this field is based on its commitment
to national drug policies and the concept of essential drugs and vaccines.
HIV/AIDS provides a striking illustration of how much remains to be done before the
potential benefits of the life sciences can actually reach those who need them most.
In recent years, research on HIV/AIDS has made staggering progress and treatments now
exist which greatly prolong and improve the quality of life of affected people. But the
mix of drugs needed can cost up to US$18,000 per patient per year. However, 90 per cent of
the 30 million people with HIV/AIDS live in developing countries, many of which have an
annual health budget of less than US$10 per inhabitant.
We need to focus on providing those 90 per cent who cannot yet afford the new therapies
with at least good quality treatment for HIV-associated illnesses. At the same time we
must make every effort to ensure that progress is being made towards more equitable access
to effective but costly retroviral treatments. This is a moral obligation for all health
professionals. And, for the countries that have signed the Universal Declaration of Human
Rights, it is a matter of respecting their commitment to uphold the right of every
individual to "share in scientific advancement and its benefits".
This commitment should not be taken lightly. It is an essential part of our common
future and well-being. And for millions of people today, it is a matter of life and death.
WHO also has an important role to play in helping to clarify ethical issues related to
health. This is true in the area of health policies and allocation of resources, to ensure
equitable access to care for all.
It is also true in the area of bioethics where we work in close collaboration with
governments, national ethics review boards and other international bodies such as UNESCO,
FAO, the Council of Europe and the European Commission. We are currently working on
guiding principles, codes of practice for the health professions, and recommendations to
Member States in areas such as organ transplantation, clinical research on human subjects
and applications of new technology such as cloning and genetic manipulation.
The Foundation Marcel Mérieux, a long-standing and very active WHO Collaborating
Centre, has hosted the meetings of our Task Force on organ transplantation in 1996 and
1997, and supported public debate on the ethics of public health policies and
international cooperation.
A critical task for WHO is also to help countries build up their capacity for health
research and development. We must help bridge the gap between industrialized and
developing countries in terms of human resource development, and access to knowledge. Many
developing countries still lack the scientific and institutional capacity to tackle their
particular problems, in fields such as biomedicine, epidemiology, advanced technology and
social sciences.
This critical situation gets even worse when some of the best brains from developing
countries are taken away to wealthy research laboratories in developed countries. There is
no quick fix to change this. But we need to look into structures and incentives which can
halt this trend.
WHO puts an emphasis on capacity building in developing countries. It is an objective
of our own research programmes - and we try to contribute further by supporting and
encouraging collaborating centres. But we also need to stimulate private industry to
support this capacity building.
Putting knowledge at the service of humanity has been a challenge which has followed
human beings since the early civilizations. WHO is committed to do its part - to foster,
renew and harness a global public good. The countries of the world spend a daunting 2,300
billion dollars on health care every year - and the figure is rising. We are convinced
that our advice - our global outlook and our evidence base can guide countries in making
wiser choices.
In pursuing this work I have pledged to reach out to our partners in the public and
private sector. We welcome all contributions, including those of industry,
non-governmental organizations and civil society. We are strengthening our links with
other agencies such as the World Bank, the IMF, the OECD and UNESCO. We look forward to
participating in the World Conference on Science in Budapest in June 1999, and would like
to thank UNESCO and ICSU for having invited us to run the panel on "The Biological
Revolution and its Implications for Health".
The researcher has to strike a difficult balance. She needs to build on evidence. But
she also needs to take risks. She needs to go for her vision - to reach one step further
than anyone has done before.
In health we have seen it so many times. Decades ago a polio vaccine was just a dream.
The debate was raging between those individuals who fought for it, and those who wanted
better iron lungs and rocking beds to help alleviate the suffering of the polio victims.
As we approach the historic event of polio eradication - made possible by the
development of effective oral vaccines - we forget how difficult the decision was to keep
investing in a dream that no one could know would become a reality.
Let us keep some of the dreams alive. All our knowledge is about the past, but all our
challenges are about the future. This is what stimulates scientists and researchers to
make the extra effort.
I can assure you that WHO will be on their side.
Thank you. |
