For those of you who have previously participated in what is commonly called an MIP, I assume that this round of meetings will appear a little different.

My own message to Executive Directors and Directors before these highly valuable meetings has been to focus on change and continuity – to limit formal presentations and to set aside time to listen, learn and exchange.

The structural changes at WHO have been carefully presented and explained to you at previous occasions. I take the very clear messages from the World Health Assembly as an endorsement of the main directions we have initiated.

During these days we are exposing you to the work of clusters and departments, and we do it in a way which seeks to highlight the synergies that we are pursuing in the new structure.

I believe we have come far in less than 11 months. But there is more ground to cover. We are working hard to improve and refine the mechanisms inside the clusters, the way departments work together, the way we work across clusters, the way we refine and develop the Management Support Units and not least the way in which we link up in One WHO – with Regional Offices and countries.

Let me make some observations common to the policy guidelines of all of the clusters – and for the whole of WHO.

A broad direction has guided our formulation of programmatic priorities and the new cluster structure. We are now taking this one step further by defining a corporate strategy which helps different parts of the Organization pull in the same direction. WHO must be more than the sum of its parts, and a corporate strategy provides a basis for decision-making across the Organization.

It is in that spirit that I present to you how I see the work of the clusters fitting in to some of the broader objectives that we are defining for ourselves.

I would like to begin with the main message to the World Health Assembly last month. I pointed at the health gains of the 20^th century as one of the biggest transformations of our times. But I stressed that the century also left a legacy: More than a billion fellow human beings have been left behind in the health revolution. A lot more dedicated work is required for us to reach Health for All.

I see WHO's prime mission as contributing to bringing the excluded billion on board. More than that – our motivation should be to help reach also the other billion fellow human beings who are poor and who do not have the access they need to fundamental health services.

We 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. Inequities in health have to be addressed – also in the richer countries.

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 has 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 will suffer.

We need a new agenda to approach this complex area – and I believe that this agenda may now be taking shape. Before the World Health Assembly, I met in London with the leading providers of bilateral development assistance as well as with countries from the regions. Many of your organizations were represented. Our objective was to start a dialogue on the potential for health-led development.

I believe that the development 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. Above all it will require a new collaborative effort.

The participants in London agreed on 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.

The meeting also agreed that national health policies and budgets need to be geared at better addressing the health of the poor – even within existing severe resource restraints. We know that a limited set of conditions continue to affect the poor disproportionately. In poor countries only eight conditions – five of children and three of adults – still account for over one third of all healthy life lost. In some countries the percentage is even far higher.

The agenda emerging from London fits well with the directions WHO has been developing during a year of change and the broad guidelines from Health for All.

Looking ahead the World Health Report 1999 concludes with four major challenges in the next decade:

The first concerns what I have just discussed - the need to focus on the health of the poor and the interventions that can make the largest difference.

Many clusters have their contributions to make but the other three challenges also define overarching themes that link the clusters to common goals.

The second challenge is that health systems must proactively counter potential threats to health resulting from economic crises, unhealthy environments and risky behaviour. Cleaner air and water, adequate sanitation, healthy diets and safer transportation – all are key issues.

Third, there is a need to develop more effective health systems. In many parts of the world health systems are ill-equipped to cope with present demands, let alone those they will face in the future.

And finally, there is a need to be expanding the knowledge base that made the 20^th century revolution in health possible – and that will provide us the tools for continued gains in the 21^st century.

These challenges provide a sense of direction – for national governments, for members of the international community and for WHO as well.

That goes for all of the clusters and the Regional Offices – but let me make some specific comments relating to the clusters you are meeting this week.

Let me begin with the knowledge base. The whole of WHO is now benefiting from a systematic collection and analysis of information and evidence in the Evidence and Information for Policy cluster.

This cluster was established to strengthen the scientific and ethical foundations of health policies and programmes. The purpose is clear: To better enable WHO and its Member States achieve their goals by providing evidence of policies which promote equity, quality and efficiency. The challenge now is to make sure that the information which is produced reaches those who make the critical decisions.

This cluster will help us better define the burden of disease, especially among the poor. This will also help us cover an important part of the follow-up of the London meeting.

It will help us look ahead and better foresee emerging threats and health trends and provide advice to governments on early action and preventive measures. It will help gather information on successes and failures of health sector reform. And it will help produce yardsticks of health systems that are equitable and effective under resource restraints.

The Communicable Disease cluster – which will meets its Interested Partners next week – provides the technical underpinning for our work in combating the most important causes of ill health in many parts of the world. Communicable diseases remain the daunting burden of the poor. For WHO the work in this area will remain a backbone in the future.

The cluster on Sustainable Development and Healthy Environments has a special role to play in addressing the health situation of the poor. I have asked the Health in Sustainable Development Department to serve as the secretariat of the follow-up to the London meeting.

This cluster will help us pull together all of the factors outside of the formal health sector that influence the health of the poor. In some areas we are already strong, such as in the environmental field. Poverty is in itself the biggest polluter. We know that poor people suffer more from environmental degradation than those who are better off. But we need to go further and understand the potential health impact of all aspects of government policy.

We also know that nutrition is key for all, but especially for the poor who miss the critical intake of required vitamins and micro-nutrients – with devastating effects on their physical and mental health.

The Social Change and Mental Health cluster not only deals with major causes of ill-health. The very notion of social change helps us focus on the causes of exclusion – not just from health care but from all other essential social services. We are only just beginning to realize the seriousness of depression as a cause of suffering and disability. WHO is gearing up its work in this area to better understand its causes and possible treatments.

The Non-communicable Disease cluster was established to help Member States prepare for what is turning out to be a growing epidemic – requiring new and different strategies of prevention – posing especially hard challenges to countries in transition, faced as they are with the double burden of disease.

Tobacco is the prime example of emerging epidemics. We know the threats. We know the growing number of smokers. And we can tell countries what they may be facing in only a generation if they fail to act.

A few months ago interested partners met with the Health Technology and Pharmaceuticals cluster. We need to remember how their contribution also fits into our broader agenda. Getting essential medicines and technologies to places where they are needed most at prices people can afford is key to any effort to safeguard health and protect people from financial exploitation.

Let me then move on to the cluster on Health Systems and Community Health. Its work will be key in shaping WHO practical response to the struggle against poverty. And its work will bring together for the ultimate user the valuable work on health finance and health systems from several clusters.

Child and adolescent health – for example – is key.

It is impossible to contemplate a healthy world 10 to 20 years from now, if children do not get a healthy start in life – the early access to primary health care, to immunization, to clean water and the right nutrition. Indeed meeting these goals is essential to the definition of a successful health system.

One concrete result of our corporate approach is what we try to achieve through Roll Back Malaria. Of the main afflictions of humankind, malaria is the disease most concentrated among the poor; and the ones who carry the greatest burden of this disease are the children. While Roll Back Malaria is located in a cluster dealing with communicable disease, health systems remain critical to its success. Also critical will be development of new drugs and ultimately a vaccine.

Another synergy is the link between child and adolescent health and tobacco use. The evidence base provides striking knowledge between tobacco use and death and disease. And addiction starts in youth. We have initiated close cooperation between the Child and Adolescent Health department and the Tobacco Free Initiative on ways to reach more adolescents and strengthen their ability to make sound decisions that affect their health.

This cluster will also house the Organization-wide work to address the HIV/AIDS epidemic. We know the daunting reality – and we learnt a lot about how Member States deal with it during the Round Table discussions at the World Health Assembly. We are working to draw on the knowledge and expertise in all clusters. We are beginning to understand that the threat posed by HIV/AIDS is one of the main factors which could prevent us from achieving the international development goals.

I mentioned our ambition to reduce greatly the burden of excess mortality and morbidity among the poor. That means a renewed focus on women's health. Women who count for 70 per cent of the poor and carry the by far largest burden of health care in communities throughout the world need our support and active follow-up of the international conferences such as the Beijing Women's Conference.

We will also push forward our work, including our research, on reproductive health. The HRP Special Programme remains a unique resource base that WHO is ready to take forward with its partners.

Then there is the important agenda of bringing down maternal mortality which remains the most striking illustration of inequities between the rich and the poor. Last February we met in the Hague to review the progress made since Cairo five years ago. At that time I pledged maximum effort to address maternal mortality. I reiterated this commitment in Mozambique last April when addressing an advocacy meeting on maternal mortality.

The department of Health Systems is working with countries to build their capacities, to improve their health systems and to make them more responsive to the health needs of the population.

We know the reality. In many countries health systems are over stretched, under funded and under staffed. Many countries spend their scarce resources in a far from optimal way. We may help reverse that trend – with new knowledge, with more influential partnerships and a better mobilization of our technical programmes to help supporting the health systems they are there to serve.

WHO needs to integrate a health sector development and health finance perspective into everything we do. We are driving a process of cultural change through the Cabinet Project on Partnership for Health Sector Development. In our World Health Report 2000 we will amplify and operationalize the directions for finance and health system development that we introduced in this year's report.

Dear participants,

The bottom line of all our work must be measured on the ground. The emerging corporate strategy reflects how the work of our clusters and departments bring diverse capacities to bear on meeting key health challenges. The accompanying step is to strengthen the coordination between Headquarters, Regional Offices and country offices. Our target is the One WHO country programme where we effectively can draw on all the strengths of what WHO can offer.

In two weeks I will bring together the Executive Directors for a two-day retreat to start the follow up of the World Health Assembly and the first steps towards a new budget – for 2002-2003. In three weeks I will bring together for the first time the Global Cabinet – where I will meet with the Regional Directors to address strategic issues for WHO.

Clearly, the technical and political challenges for WHO entering the next century, in a situation with considerable budgetary constraints will underline to all staff that we must be looking at synergies, efficiencies and further improved outputs from our work – as One WHO.

In preparing for this challenging future the exchange with our Interested Partners is of key value. I welcome you once again to WHO and together with my colleagues we look forward to continued discussions.