WHO Geneva,
11 May 1999

Introduction to the launch of the World Health Report

This is the last World Health Report of the century, and the first report that I have issued as Director-General of WHO. It reviews the remarkable health achievements and looks ahead to the challenges and opportunities for better health for more of the world population.

First, let me mention two key points:

The great health achievements of the 20^th century count as one of the biggest social transformations of our century. Living conditions dramatically improved for the large majority of human beings. From an undifferentiated domestic activity, health care has grown into a vast industry absorbing 9 per cent of world wealth – more than 2.000 billion dollars annually.

But the century left a legacy. More than a billion fellow human beings have been left behind the health revolution.

So, the first message is: Now, we must bring the excluded billion on board. It can be done. We know what it will take. We can go a long way in only a decade.

I see this as the single most important challenge – to help lift the poor out of poverty. We have for long argued this as a moral obligation. But this report argues that combating poverty through better health is also sound economics.

That will – I believe – attract the attention of decision-makers beyond the ministries of health. And that is exactly what we need. We need to remind Presidents, Prime Ministers and Finance Ministers that they are health ministers themselves.

To take one example: A five-year difference in life-expectancy between two otherwise similar countries can benefit economically the more healthy country by half a per cent higher growth rate per year. The accumulating effect of such a difference is significant in development terms.

Reducing greatly the burden of excess mortality and morbidity suffered by the poor will mean focusing more on interventions that we know can achieve the greatest possible health gain – such as giving renewed attention to diseases like tuberculosis, malaria and HIV/AIDS – diseases which strongly hit the poor.

We also know that women and children suffer more than men. There is a need to invest more in reducing maternal mortality. Last month – in Mozambique – I attended a conference on maternal mortality where the government of Dr Mocumbi lent its support to increased efforts to cut the maternal mortality rates.

Think about it: Whereas 1 out of more than 4000 women in Europe or the United States risk dying from giving birth, that figure can be as high as 1 out of 16 in the countries worst off. Just imagine the added burden: The tragic consequences for the child, for the rest of the family and for the entire community when a woman in her best years passes away.

The second message of the report is to look ahead and make the right decisions in time. In health the success stories often give rise to new challenges. If we succeed in curbing poverty and giving populations a real chance to climb the development ladder, new health threats will follow, from the non-communicable diseases, from the very fact that people live longer, from changing life styles and from exposure to threats such as tobacco.

So we are saying; let us prepare wisely. Let us focus on what it will take for the health sector to cope in the years to come. There needs to be primary health care, access to essential drugs and vaccines and trained personnel. A major transition in the way the health systems are structured and financed will have to take place in a very short time – and often under very severe financial constraints.

Take the tobacco epidemic as an example: If unchecked we expect the number of smokers to rise from 1 billion today to about 1.6 billion some twenty years from now. That will increase the number of tobacco related deaths from 3.5 million today to close to 10 million in 2020 – with all the extra deaths coming in the developing world. Half of those who die from tobacco die in middle age – not in old age. And then I have not mentioned the disease and disability which would also be part of the picture. The burden on the health system will be huge.

The third message of the report is the role of knowledge. It was the expanding knowledge base which made the 20^th century health revolution possible. Knowledge improves health through two mechanisms. The most obvious one is by creating specific technologies, such as drugs and vaccines. But knowledge is also the basis for health promoting behaviours. People wash their hand because of the discoveries about microbes. They practise safe sex because what they know about AIDS and other sexually transmitted diseases. They quit smoking because of they grasp the overwhelming evidence that tobacco kills.

Scientific knowledge, therefore, is not something distant to people around the world. A major challenge is to spread the knowledge and to make it relevant to the way people lead their lives. It is from this knowledge base – continuously renewed and expanded – that we have to draw the answers to include the excluded billion and make the right decisions on how to lift people out of poverty.

A lot of knowledge is generated through the research of private industry and governments of high-income countries. But two important gaps are not being filled: One concerns research and development relevant to the infectious diseases that overwhelmingly afflict the poor. The other concerns the systematic generation of an information base that countries can use in shaping the future of their own health systems.

For WHO it will be a key concern to pursue a global public research agenda to help fill these gaps.

Let me finally comment on the name of the report itself: Making a Difference. For WHO this is an ambitious message. We need to focus on the interventions that really make the largest impact. It is a message to our Organization and to our Member States that we need to evaluate much more carefully how we plan, distribute and use our resources.

Health for All by the year 2000 has been the vision of our member states. Together we only achieved Health for Many – but not yet for all. Now, the unfinished agenda is including the excluded billion. That is what will really make a difference.