Ladies and Gentlemen:
I am happy to meet with the participants in the Global Forum
informed people who know the World Health Organization well and who share our commitment
to improve life for our fellow human beings through better health, better health policies
and better health research. I am pleased to see so many familiar faces from WHO's
closest network representatives of the Member States and leading representatives of
the international research community.
During my 10 months at WHO I have been calling for renewed partnerships
to help advance the role of health in development. WHO is the lead agency in health, one
of several key players. I have called for a change in our working relationship with the
other players, many of which should be our natural partners; the other UN agencies, the
private sector, the NGO community and the world of research.
I have done so for several reasons. The most obvious one is that we can
achieve more by working closer together, in particular when it comes to making a
difference where it matters most, in countries where people live.
Dispersed agencies send dispersed messages even though the sense
of the messages may be the same. We need more concerted analysis more joint
definition of the key challenges to human development and more jointly defined
strategies to implement our programmes and policies.
There is another important reason for working together, and that is to
give greater strength to our voice and our advocacy role. Because we have an important
message to get across to decision makers beyond the Ministers of Health to the
Prime Ministers and Finance Ministers who need to be reminded that they are indeed Health
We know that not only does ill-health lead to poverty. We also know
that it works the other way around: poverty leads to and perpetuates ill-health. We know
the critical role of health in the forging of sustainable development. We know how much it
matters that investments are made according to the real needs. We know how important it is
that health systems can reach all and not only the fortunate few.
In short, we know a lot about how and why health matters and we
also know a lot about where we need to learn more where excellent research is
needed to bring us forward. Our joint undertaking is to deepen this knowledge and to place
it where it belongs - at the core of the international development agenda.
To get there we need solid facts and reliable information. WHO has the
role of providing both facts and information. Through the establishment of the Evidence
for Information and Policy cluster we are offering a new and crucial public good to our
My vision of WHO is that of a global resource centre, of recognized
relevance and excellence. To achieve this, WHO will network and tap the knowledge and
expertise of scientists from all over the world, operating at different levels, in
different sectors and disciplines. The development agencies, the research community,
health workers and end-users must all be involved.
In this undertaking the Global Forum is key. As the Chairman, Dr Ade
Lucas, stated at the opening of this meeting yesterday, the Forum is a neutral platform
where all stakeholders can interact. Indeed, the enormous value of the Forum lies in its
convening capacity, whereby producers, funders and users of health research can engage in
a constructive dialogue.
I welcome the way in which WHO and the Global Forum have come closer
during the last year and I look forward to all the exciting initiatives which are
there for us to pursue together.
The close link between research, advocacy and decision-making will be
crucial in the years ahead. What lies ahead?
In my address to the World Health Assembly last month, I pointed at the
health gains of the 20th century as one of the biggest transformations of our
times. But the century also left a legacy: More than a billion fellow human beings have
been left behind in the health revolution.
I see WHO's prime mission as contributing to bringing that
excluded billion on board. I believe this can be done, not by better health policies and
better health research alone, but by a concerted global effort where health is given the
crucial part it deserves. The world has the knowledge and the means to address the
unfinished health agenda of the 20th century. We know what it will take and we
can go a long way in the next decade.
We need to focus on the poorest of the poor. They are at the very heart
of the work of WHO as well as the efforts of the Global Forum for Health Research.
But we also need to broaden our reading of poverty. We talk about the
poor, but still know too little about who they are, the causes of their poverty or how
best to reach them. Yesterday Julio Frenk and Chris Murray showed you how inequities are
deepening between nations and within them. Poverty cannot be measured by income levels
A poverty spiral is triggered when health systems fail to reach all. We
see it in many African countries where less than half of the population have access to
functioning health systems. We saw it last year in parts of Asia when economic hardship
hit the public sector and even primary health stations had to close. Generations may
Before the World Health Assembly, I met in London with the leading
providers of bilateral development assistance. Our objective was to start a dialogue on
the potential for health-led development. We have all signed up to the International
Development Goals, and we should all accept joint responsibility for their achievement.
I believe that the goal of halving the number of people living in
absolute poverty by 2015 is attainable. But it will require new ways of working and
changes in the way we use our resources. And - above all it will require a
The participants agreed to the need for increased studies of how health
investments can be a cornerstone of poverty reduction. WHO will take on this agenda and
initiate research on the links between health and poverty reduction, and to document best
practice of policies aimed at helping the poor and reducing poverty.
We also agreed that national health policies and budgets need to be
geared at better addressing the health of the poorest even within existing severe
resource restraints. We know that a limited set of conditions continue to affect the poor
disproportionately. In poor countries, 5 childhood conditions still account for up to 40
per cent of all healthy life lost. WHO will continue to build its evidence base on
priority interventions and health systems, and develop strategies for ensuring continued
investment in international public goods, particularly technologies that help tackle the
health conditions of the poorest.
And finally we agreed that approaches to external assistance in
health sectors are changing and that we need to push forward towards more strategic
collaboration at both national and international levels. WHO will take initiatives to
convene inter-agency fora on sector-wide approaches to better anchor the role of health as
a tool to lift populations out of poverty.
Out of this process an important research agenda is emerging and WHO
will be working in the months ahead to put forward specific proposals.
At the doorsteps to a new century, we know that knowledge and
the dissemination and use of it will play a crucial role.
Knowledge leads to better health through two major mechanisms. The
first and most obvious one is the development of better technologies. But there is also a
deeper connection. Scientific knowledge helps to structure human experience as it provides
an explanatory framework and a guide to health-promoting behaviours. If people wash their
hands, it is because of the discoveries about infections. If people practise safe sex, it
is partly because of the epidemiological research on the transmission of HIV. If people
quit smoking, it is thanks to the overwhelming evidence that tobacco kills.
Research is not a distant endeavour carried out in ivory towers. Its
products feed into the daily life of ordinary people. If anything, we must strive for a
more expeditious utilization of research results and for more universal access to its
There is every reason to expect that focused investments by health
systems on specific problems of the poor can generate major short to medium term gains in
health, and that investment in R&D can sustain medium to long term gains. Such gains
are of immense intrinsic value.
The Global Forum For Health Research can play a major role. Its role is
to focus research efforts on the health problems of the majority of the world's
population, particularly the poor, by improving the allocation of research funds and by
facilitating collaboration among partners. It is to address the grave disparity widely
referred to as the 10/90 disequilibrium.
Let us pause here to remind ourselves briefly of the sequence of events
in recent years that have helped bring us here with a common purpose today.
Almost ten years ago, in 1990, the World Health Assembly emphasized the
need to develop health research and the necessary knowledge on which national health
policies should be based.
That same year, following the Nobel Conference, the concept of
Essential National Health Research took root. On that basis, the Council on Health
Research for Development (COHRED) has developed collaboration with developing countries
and gathered useful experience.
In 1993 the World Bank focused its World Development Report on
health, and underscored the central importance of research.
In 1996, the WHO Ad Hoc Committee on Health Research Priorities
published a well-documented report on the need and criteria for investing in health
research and development and the Global Forum for Health Research was established. A few
months ago, the Forum published its report on the disequilibrium between health needs and
the allocation of research resources.
Only last month, the World Health Report 1999 demonstrated that
a large proportion of the health achievements of the 20th century can be attributed to
advances in scientific knowledge as they were translated into more effective technologies
and health-promoting behaviours.
Health research is the ultimate international public good. The research
priorities we set for ourselves today determine the health agenda, health practices and
technologies of tomorrow. In addressing today's challenges, we base our policies and
action on existing scientific knowledge and lessons drawn from the past. But research must
also help us anticipate future challenges. Sustainable development and sound health
policies require foresight and long term planning.
We must help correct the disequilibrium in health research spending.
Much of the research that is aimed at reaching the developed world may
benefit larger parts of the world population. But at least two critical gaps remain. 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.
We need to foster new thinking on research and its major potential
contribution not just to technical problems but also to the decision-making process on
health and overall development policies and priorities.
Research, at the highest scientific level, can be coupled with policies
and concrete interventions for meeting health needs. And, even more importantly, the
outputs of such research can be translated into action that will help tackle effectively
the problems of the poor.
We should place particular emphasis on research capacity strengthening
. One fifth of humanity still has no access to health services, and one half lacks regular
access to essential drugs. This must be present in our minds as we promote health
research, capacity building, poverty elimination and sustainable development.
Today, formal health services represent a vast industry absorbing 9 per
cent of the world product - more than 2 000 billion dollars per year. But as we know,
there is an inverse relationship between the distribution of need and the distribution of
Such imbalances are multiplied within countries. All over the world,
national health systems misallocate resources to interventions of low quality or of low
efficacy related to cost. Large numbers of people forego essential care or suffer huge
financial burdens resulting from an unexpected need for expensive services.
While this is an area that requires more analysis, there is growing
evidence from a number of countries that the poor spend a higher proportion of household
income on out-of-pocket payments for health services.
The trend is clear: Catastrophic expenditures in health care have
become one more source of deepening poverty.
With notable exceptions, most low and middle-income countries have not
fully developed the solidarity basis for health care financing that counts among the major
social achievements of the 20th century in all but a few of the industrialized nations.
This is another side of the unfinished agenda that overburdens the poor.
Health research is at the core of finishing that agenda. And it is at
the core of our work in WHO. Progress in health depends on research and scientific
breakthroughs for the development of new and improved biomedical tools. Obvious examples
include the need for new and effective antimicrobials, and for safe, easy-to-use and
affordable drugs and vaccines against infectious diseases such as malaria and HIV/AIDS.
A key component of the reform of WHO has been to strengthen our
evidence base and the research policy that feeds it. In 1999 I decided to review the
unique role that WHO can play in research and development and, in particular, in promoting
and supporting essential health research that will raise the standard of health in
developing countries and in deprived sub-groups of developed countries.
This review led us to reconsider the internal mechanisms for supporting
the efforts of WHO in research and development. To this effect I appointed an internal
working group and an external board of advisers to work with us and to propose to the
Executive Board, just last May, effective mechanisms to direct the Organization's
policy and programmes in this area.
These proposals have included, among others, the systematization of
research promotion throughout WHO, periodic external reviews of all technical programmes,
and reviews of research proposals for their scientific relevance and ethical adequacy. We
have confirmed Expert Committees as one of the key links of WHO with the scientific
community and have modified the organization of their meetings and the selection of their
members to keep up with the rapid pace of science.
We have reviewed the strategic role of the Advisory Committee on Health
Research to make its advice available on a continuing basis and to give it the authority
to establish ad hoc committees in order to examine specific or urgent matters. In
line with these reforms, the Department of Research Promotion and Cooperation has been
revamped and a new Director, Dr Tikki Pang, a distinguished Indonesian researcher, has
been recruited through a competitive and transparent process.
Today's social transformations happen very
fast. During a few decades close to 90% of the world's population have been exposed
to the double burden of disease. Most of the countries suffer an epidemiological backlog
of common infections, malnutrition and reproductive health problems. While still facing
these challenges, they are also confronted with new and emerging problems. These include
noncommunicable diseases, new infectious agents, and the growing problems of substance
abuse and injury from accidents and violence.
Nothing better illustrates the double burden of disease than the twin
problems of tobacco addiction and resurgent malaria, which are among WHO's biggest
priorities. At the same time, these are examples of how research and development have
given us tools to address them.
For malaria, science has provided a sequence of drugs active against
the parasite; a sequence of insecticides (and now insecticide-impregnated bednets) to
control the vector; and improved clinical and public health knowledge about how to apply
Our most important tool for control of tobacco use is knowledge itself
- knowledge that tobacco kills, and how. Knowledge that addiction in children can lead to
lifelong dependency. This knowledge has been essential both to motivate control and to
target our efforts. And this knowledge is the fruit of systematic, sustained
So we start with good tools for control. But our goals are ambitious
and the problems are numerous. Malaria parasites rapidly develop drug resistance - so we
need new drugs, and a vaccine. Tobacco dealers are switching their targets to the youth of
the developing world; we must learn how to respond. Continued investment in new knowledge
Looking ahead we see complexity and opportunity. In the World Health
Report 1999 we are sending a cautiously optimistic message. With successful leadership
the world could end the first decade of the 21st century with notable accomplishments.
With the right decisions and let me stress cost-effective decisions
most of the world's poor would no longer suffer today's burden of premature
death and excessive disability, and poverty itself would be much reduced. Healthy life
expectancy would increase for all. Smoking and other risks to health would fade in
Progress in the 20th century points to the feasibility of reaching
these goals. Further advancement in the 21st century will demand that we compress the time
required to accomplish results. We are summing up the challenge in four major points:
First and foremost, there is a need to reduce greatly the burden of
excess mortality and morbidity suffered by the poor.
Second, health systems must proactively counter potential threats to
health resulting from economic crises, unhealthy environments or risky behaviour.
Third, we need to help countries develop more effective health systems,
better equipped to address the real health challenges confronting the people.
And fourth, there is knowledge. We need to invest in expanding the
knowledge base that made the 20th century revolution in health possible, and that will
provide the tools for continued gains in the 21st century.
These four challenges provide a sense of direction - for national
governments, for members of the international community and for WHO as well. Each of these
diverse actors will have its own specific needs, values and capacities; and each may find
some of the challenges of little relevance to its own circumstances. What is important for
each, however, is to focus its resources where they can make a difference.
Let me close by quoting the words of a distinguished researcher, Sir
Peter Medawar. In 1967 he wrote: "If politics is the art of the possible, science is
the art of the soluble."
In my own personal life I have traversed the road from science to
politics. From my research career I was called to public service in my country. Now I find
myself leading an international organization that bestrides the worlds of science and of
From my experience I can attest to the enlightening and empowering
effects that a politician experiences when science puts solutions in his or her hands.
After all, that is the essence of research: to search and search again for answers.
One of our biggest challenges is to close the gap that so often
separates the possible from the soluble. For this, we must construct a permanent dialogue
between decision makers and researchers. This is the sort of bridge that the Forum is
engaged in building.
Our waning century has left us an important lesson: That human progress
is possible only when we join hands. Health is a shared responsibility. Through our
partnership we can fulfil the promise of a better future for all.