Mr Chairman
Colleagues :

Since I was elected Director-General of the World Health Organization and throughout my ten months in office, I have been calling for renewed partnerships to help advance the role of health in development. I have called for a change in our working relationship with the other players, many of whom are our natural partners: the other UN agencies, the private sector, the NGO community and the world of research.

It is in this spirit that I have the great pleasure to address such a broad group of partners. We have different roles to play. But we are aiming for that same goal: Help foster equitable human development – help lift populations out of poverty – help men and women realize their potential and stretch towards new heights and new frontiers.

We are leaving a century of remarkable human progress. The health gains of the 20th century count as one of the biggest social transformations of our times. Living conditions have dramatically improved for the large majority of human beings.

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

One month ago I told the health ministers of the world at the World Health Assembly: We must bring the excluded billion on board. More than that – our mission is also to help reach the other billions of fellow human beings who are poor and who do not have the access they need to fundamental health services.

And I stressed: This is a time for leadership. Humankind has never made progress by giving in to complexity. This is a time for cool heads and warm hearts.

With vision, realism and commitment the world could end the first decade of the 21st century with some notable accomplishments. It will take global leadership to set the process in motion, and WHO is ready to play its role – working to the best of its ability – linking up with its partners – linking up with all of you – to unleash a global social movement for health and the role of health in development.

Let me share with you what I see as our main challenges and let me start with poverty itself.

At the centre of the growing consensus on future development needs is a widespread sense of urgency to drastically reduce the numbers of very poor people. Poverty undermines development. Poverty is an attack on human rights and human dignity. Poverty creates political and social instability. A recent study examining conflicts around the world found that most of today's wars are fuelled by poverty, not by ideology.

Countries simply cannot afford massive poverty. The world cannot afford it. Sustainable development for future generations will be a non-starter unless poverty is radically reduced, and extreme poverty eliminated.

Of particular interest to us is the role of health in combating poverty. We have known for a long time that ill-health leads to poverty. We now know that it also 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. Health gains trigger economies to grow. We know how important it is to focus on the right interventions. Health systems need to reach all and not only the fortunate few.

In short, we know a lot about how and why health matters. Health is key to reversing the downward spiral linking poverty, malnutrition and environmental degradation. Good health enhances the capabilities of the poor, builds social and human capabilities which, in turn, advances the productivity of people, communities and societies. This is what human development is all about.

We also know a lot about where we need to learn more. We need to better know who are the poor and how we best can reach them. The challenge stretches into the developed countries. Poverty levels in affluent countries vary between 7 and 17 per cent of their populations. That adds up to more than 100 million people.

We need a shift in our thinking and a shift in the way resources flow. Whereas 90% of the disease burden is in the developing countries, these countries have only got access to 10% of the resources going to health.

This cannot change overnight, but it has to change. The G8 leaders took an important step when they decided on a package of debt relief last weekend. But we need new and bolder steps. About 700 million people are living in countries strapped in servicing their debt, severely limiting their potential for development.

I believe the financial institutions need a set of new and additional criteria when they consider the issues of new loans as well as debt relief. Conditionality based on macro-economic indicators alone will not tell the full story of how a country is advancing or regressing. Creditors should take a much closer look at health and other social indicators when they consider which countries should qualify for debt relief and future support.

The message is simple: Investing wisely in health – as measured by trends in maternal mortality, infant mortality, immunization rates or even degree of universal coverage -can tell far more about a country's future potential than the narrow return from tourism or road building.

We need new knowledge and evidence to take these messages forward and WHO is investing in its knowledge base to contribute to that end.

Think about it: In poor countries, it would take very little to increase life expectancy by addressing the main killers of children and adolescents. A five-year difference in life expectancy may yield an extra annual growth of 0.5%.

Modest improvements in health can lead to powerful boosts to development.

We should not be aiming at modest gains. In East Asia, life expectancy increased by over 18 years in the two decades that preceded the most dramatic economic take-off in history. Repeat these gains - and we could be launching a new leap forward for human progress and development.

What then, are the specific health challenges?

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

First and foremost, there is the need to reduce greatly the burden of excess mortality and morbidity suffered by the poor, and let me spend most of my time on this prime challenge.

Reducing the burden will mean focusing more on interventions that we know can achieve the greatest health gain possible within prevailing resource limits. It will mean giving renewed attention to diseases like tuberculosis, which disproportionately affect poor people, as well as malaria and HIV/AIDS – which we now recognize as major constraints to economic growth.

We have to focus more on women who suffer poverty more than men. 70 per cent of the poor are women and they carry more than a fair share of the health care burden. We need a real focus on women's health to take forward an critical agenda, defined and strengthened in Beijing four years ago.

We need to take the reproductive health agenda forward with a broad vision of giving women, men and families a safe environment where they can safely plan and decide on their own future.

Five years after the population summit in Cairo there is no time for complacency. WHO recommits to taking reproductive health research forward with its partners. And we pledge to make an extra effort to make pregnancy safer.

In parts of Africa, women face a one in 16 risk of death because they do not receive the care they need when they are pregnant. By contrast, in most of Europe and North America, such a tragedy will hit only one woman in 4 000.

No other indicator so starkly reflects the disparities between the developed and developing worlds. Small wonder that African mothers, about to give birth, sometimes bid their older children farewell, telling them "I am going to the sea to fetch a new baby but the journey is long and dangerous."

Every death is a tragedy. The death of a young woman, who may have other children, is a multiple tragedy. The loss of the mother is often associated with the death of the infant for whom her life has been sacrificed, followed by the impaired health and nutrition of the remaining children.

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.

The leading risk factor of ill-health remains malnutrition. And the poor are often caught in the worst of traps, suffering from both malnutrition and intense exposure to infectious diseases. Separately, the effect of each is huge. Together, their impact is far greater than the sum of their parts.

Both are conditions of poverty. They arise from poverty and they keep people in poverty; not just for one generation, but for many generations.

In a well-nourished child, a common infectious disease is usually a passing illness. In a malnourished child, the same disease can precipitate life-long disabilities such as blindness. And a rapid sequence of common infection and malnutrition leads to death.

This is just another example of self-perpetuating poverty spirals. But remember that affordable tools exist to address almost all of them.

We have the evidence of what works. Still infectious diseases are a neglected concern within the social and economic development sector. In 1990, bilateral, multilateral, foundation and NGO partners provided just over US$800 million to help developing countries in their control efforts. This represents less than 2% of total donated funds. This has to change.

The survey which was conducted by the Global Health Council shows the concern expressed by US citizens about the peril of infectious diseases to their own health and to the health of the billions who live in developing countries. They are right. In this world there are no health sanctuaries.

A few days ago WHO released its own report on communicable disease. We have called it Removing Obstacles to Health Development. The report underscores the risks. But more importantly it points to actions that would enable us to keep infectious diseases under control and to mitigate their impact.

One in every two deaths among young working age adults and children worldwide are caused by just six infectious diseases: AIDS, malaria, tuberculosis, measles, diarrhoeal diseases and respiratory diseases such as pneumonia. A person can be cured or protected from each one of these diseases for less than the cost of a bottle of aspirin. Half of these killers can be stopped for under 35 US cents, less than the cost of this morning's newspaper.

Or take another example: One of the most important interventions in interrupting the link between malnutrition and infection is vitamin A supplementation. Routine supplementation in the age range 6 to 72 months can reduce overall mortality by almost 25 per cent.

Making a difference in the fight against these killers means making a true difference against poverty.

Let me then turn to the other three of the four challenges that WHO has defined.

The second challenge is concerned with the ability of health systems to proactively counter threats to health resulting from economic crises, unhealthy environments and risky behaviour.

Today we have evidence to know what the disease burden may look like a generation from now. We need to spend our time wisely to prepare and prevent.

Looking ahead towards 2020 let me mention just two of the threats we have to face.

The first is the mounting burden of mental illness. For too long this has been a neglected area – in rich and poor countries alike. WHO is gearing up its work – not only to better understand the causes of depression but also to intensify the search for better treatment.

The second threat relates to an emerging epidemic. I am talking about a major cause of premature death, one which is dramatically increasing - killing four million people this year - and, if we let it go on unchecked, 10 million in 20-30 years - half of whom will be dying in middle age - not old age – and with all the additional deaths coming in the developing world.

I am talking about tobacco. I have told the World Health Assembly: I am a doctor. I believe in science and evidence. Tobacco is a killer. It should not be advertised, subsidized or glamourized.

We need a broad alliance against tobacco, calling a wide range of partners to halt the relentless increase in global tobacco consumption. This is a medical challenge. But it is also a cultural, economic and social challenge. You, the NGO community, the research community and all those committed to public health need to take part.

The third challenge calls for 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. Poor countries will be faced with the double burden of disease, one coming from communicable diseases and the other from the emerging non-communicable diseases.

In WHO we have defined health sector development as a priority for all our work. When we help Roll Back Malaria, we wish to see a strengthened health system as a result – a health system which can take on more effectively the combat against tuberculosis or HIV/AIDS.

A part of this agenda is the complex issue of how to finance the health sector without placing an ever greater financial burden on the poor. We need financing strategies which rely on solidarity and avoid exclusion. Equity is key – not only as a moral imperative but also as a key criteria for broader economic efficiency. The nation which spends by far the most on health care is not the nation with the most efficient system. If the systems fails to reach all, then another downward spiral is triggered. WHO will devote new attention to these issues in the time to come.

And finally, there is the fourth challenge; the need to keep expanding the knowledge base that made the 20^th century revolution in health possible – and that will provide us with the tools for continued gains in the 21^st century. At the doorstep 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 benefits.

Think about it. For many years the researchers struggled to find a polio vaccine. The debate went between those who thought resources should be spent on new iron lungs for the patients or new research for a vaccine. We are now approaching the historic event of polio eradication - made possible by the development of effective oral vaccines. We often forget how difficult the decision was to keep investing in a dream that no one could know would become a reality.

Now we know that it may happen in only 18 months from now. WHO is leading the home stretch of the polio eradication campaign. We may succeed, but we will need intense mobilization – to fill the remaining resource gaps – to reach children in the remaining pockets - and to drive forward the extraordinary alliance of governments, thousands and thousands of volunteers and the remarkable supporters such as Rotary International.

A great prize may be waiting all of us: A world rid of polio and smallpox as a gift to the new generations of the 21^st century.

Dear participants,

The global development agenda is daunting. I believe we can achieve the goal of halving the number of poor people by 2015. But it will require broad effort to mobilize the right action among decision-shapers as well as decision-makers. We need to remind Presidents, Prime Ministers and Finance Ministers that they are truly health ministers themselves.

The public health community has to step out of professional confinements and take an active part in the shaping of the political agenda. Too many public health professionals regard politics as an obstacle to what they see as rational decision-making rather than an essential part of democratic governance. This too has to change.

I look forward to engaging in this endeavour in collaboration with a broad range of partners. We have a window of opportunity. It may not remain open for long. So let us seize the opportunity and make a lasting difference together.