WHO's Vision for Health

ICN President, Dr Kirsten Stallknecht,
ICN Executive Director, Dr Judith Oulton,
Distinguished guests,
Ladies and Gentlemen,

As you celebrate 100 years of unity, I can bring you a strong message from the last World Health Assembly of the century, when delegate after delegate made reference to the key role of nursing in facing the challenges of world health. On behalf of the World Health Organization I convey our sincere congratulations as you enter a year of well-merited celebrations.

Looking at the dynamism of the International Council of Nurses, I am again struck by the fact that turning 100 cannot be such a bad thing. Here is dynamism and enthusiasm – enough to fill a new century with commitment and vital contributions to the cause of health.

I wish to pay tribute to the world of nurses whose great grandmothers had the vision to unite before the 19^th century drew to a close. You had enough knowledge to see that there are no health sanctuaries in this world, and that public health workers stand strong by standing united. You represent the majority of health workers in any health sector. That was true for this century. And it will be true for the next. You have every reason to look back at your achievements and your contributions. But I also know that you will take the opportunity to look ahead, to continue to be present where it is needed - to continue to make your contributions as long as people suffer, and the vulnerable need care and assistance.

We are leaving a century that has made remarkable achievements in human development. The 20^th century has seen tremendous changes with rapid population growth and an increase in life expectancy at birth by more than 30 years.

But there is an unfinished agenda of the 20^th century.

Despite the great achievements in health and technology, we are entering the new millennium with considerable health challenges:

• The increasing disparity in access to health care.
• The growing population of poor, over one billion, who do not have access to basic health and social care, regardless of availability.
• The rapid environmental changes and degradation of the environment.
• Economic recession and crises in parts of the world that affects the financing of health care.
• The inability of technology to face the epidemics and deadly threats from diseases such as HIV/AIDS, malaria and tuberculosis.
• The growing crises and emergencies such as internal conflicts, civil wars and natural disasters that affect the health delivery systems and access to care.

Let us repeat a well-known fact. Whereas 90% of the disease burden is in the developing countries, these countries have access to only 10% of the resources going to health. This cannot change overnight, but it has to change.

One-fifth of humanity has no access to modern health services and one-half lack regular access to essential drugs. For 20 years our global health strategy has been based on the principle of equity and health for all. Yet inequalities are widening under our very feet, in the developed as well as in the developing world.

Disasters have happened and are happening in parts of the world where TV cameras do not tell the stories or spread the images. The environment has emerged over the past decades as a major concern in health care and development. Water quality has become a critical health issue. Environmental threats to health are growing on a global scale. Both outdoor and indoor air pollution contribute to respiratory diseases. Global warming threatens to bring tropical diseases into northern latitudes.

It is hardly surprising that nurses have chosen to address these problems. The concern of nurses is for people's health – its promotion, maintenance and restoration. The healthy lives of people depend ultimately on the health of Planet Earth.

Nurses, as the key health professionals, are in a unique position to act as powerful advocates for a healthy planet. We need to encourage and implement preventive measures, not only in health care settings but also in the community. Linking the past and claiming the future, the ICN continues the visionary leadership through position statements such as Nurses and Natural Environment, Health Hazards and the ICN Declaration on Control of Medical Waste.

Last week I was here, in the same room, addressing Ministers of Health and Environment of Europe on the important linkages between health and environment. I am glad to see that your pre-Conference is on Nursing, Health and the Environment. Again, nurses are in the forefront. Florence Nightingale – the founder of nursing – was one of the first health professionals who in the 19^th century used evidence and unsentimental statistical data to show the strong link between better hygiene, environment and decreased death rates.

It was her observations and analysis that overturned prior dogma. There are many lessons for today as we all become more evidence-based! She realized that hygiene was responsible for more deaths than the bullets. She was also the first to use the pie diagram to summarize data, and she shared this with Queen Victoria … nurses have their roots in evidence for action!

I would like to take this opportunity to share with you the changes that are taking place at WHO and their implications for the work in international health, and to rally our forces into a new century. We needed to reform and strengthen our global institutions to focus our efforts to:

• help combat ill health
• help build healthy communities and populations
• sustain our activities by solid evidence and first class norms and standards
• reach out to established and new partners.

My pledge as Director-General of WHO is to place health where it belongs – at the core of the international development agenda. Health matters. It is a human right. And it is sound economics. Investing wisely in health spurs development.

I believe there is a shift coming. More and more decision-makers are becoming aware of the critical role of health for human development.

We will not miss this shift. We will help drive it. In that drive I include the International Council of Nurses.

Since July 1998, nine clusters have been established and have defined their mission. We are in the process of streamlining our working relations with the Regions and countries. The Organization is flatter, allowing for more direct communication. Steps have been taken to ensure a gender balance at all levels.

The reform process at WHO is a means of ensuring better delivery of WHO's contribution to building healthier communities in the next millennium. WHO should be the role model for countries in its matrix structure and practice which fully involve the health care providers, in particular the nursing and midwifery leaders, in health policy development, planning and implementation.

I am sure nurses will engage with their insights, experience and determination in developing health reform and the health agenda, and enhancing the practice of health for all people.

Making a difference is our watchword. Sound investments in health can be one of the most cost-effective ways to promote development and progress and alleviate poverty.

We need the political will and commitment to address these challenges, and they must be addressed in partnership with all the stakeholders including the UN family, NGOs, the private sector and business.

How, then, can improved health help to foster human and economic development? A recent study from Harvard University calls for a reassessment of the role played by public health in the promotion of growth. It suggests that two-thirds of the weight of Africa's growth shortfall over the last decades can be attributed to conditions linked to geography, demography and public health. Their conclusion is that policy-makers need to go beyond macroeconomic policies and market liberalization and deepen their understanding of the linkages between the physical environment and social outcomes.

There are some key questions that one must ask:

How do you raise additional funds for health when the majority of people have no formal job and increasing user fees will deter the most needy? How do you protect past investment in hospitals and yet demonstrate a clear commitment to community care? How do you reconcile the need to keep nurses and physicians in the public sector by increasing salaries without undermining public spending targets?

A new universalism – a new way of addressing universal coverage – the attainment of better health and the attainment of international development goals is needed. Universal access to quality of care remains the bedrock principle. We need to pave the way for our future generations to have equitable and sustainable health bearing in mind social justice and the right to health.

We should not lose sight of the fact that with reform we mean greater equity, quality of life, and effective utilization of resources.

I have noticed that your key conference programmes have been on care of older people, child health, cancer care and mental health, as well as on evidence-based practice, choices and competencies for practice, and human rights and health. All of these are major issues in meeting the challenges I have mentioned, and I am certain that your discussions have been provocative and fruitful. I look forward to learning more about your conclusions.

In setting the future directions for global health policy, nursing and midwifery are key elements. As nurses and midwives already constitute up to 80% of the qualified health workforce in most national health systems, they represent a potentially powerful force for bringing about the necessary changes to meet the needs of Health for All in the 21^st century. Indeed, their contribution to health services covers the whole spectrum of health care, promotion and prevention, as well as health research, planning, implementation and innovation.

Nurses, along with other health care providers, can share with us their insights and perspectives based on their direct involvement in the delivery of health services. The caring initiative needs to be streamlined at all levels of health care.

Nurses are making a major difference in:

• promoting the health of the people
• preventing illness
• curing diseases
• caring for people in distress
• supporting and guiding the disabled and handicapped
• assisting in rehabilitation
• supporting people and their families and communities to live with and adapt to chronic physical and mental illnesses; and
• alleviating suffering and assisting individuals and their families towards a peaceful death.

Evidence has shown that nurses make special contributions in:

• caring for HIV/AIDS patients and their families
• safe motherhood
• immunization programmes
• providing social support and counselling to people, especially in stressful situations
• school health initiatives:

• health education to promote healthier life styles, such as decreasing tobacco use
• educating about safe sex
• improving knowledge of good nutrition.

The reports from a range of the WHO CINDI programmes (Countrywide Integrated Noncommunicable Diseases Intervention) repeatedly make reference to the crucial role of the nurse in screening for risk factors for cardiovascular disease and stroke as well as the potential of the nurse's role in monitoring and providing counselling to those identified to be at risk.

Providing care in a variety of settings in addition to hospitals and health centres, such as schools, workplaces, rural communities, homes, and refugee camps, nurses are instrumental in the delivery of health services. It is clear that nurses are the backbone of most health care teams, especially the primary health care team.

WHO commends the commitment of nurses to care for all persons across the life cycle: pregnant women, infants, children, adolescents, adults, and the elderly; and especially their commitment to vulnerable groups, such as the poor, refugees and displaced persons, street children, and the homeless.

Just last month, the World Health Assembly presented the Léon Bernard Foundation Prize, which recognizes outstanding service in social medicine, to Mrs Debbie Emma Choongo – a nurse from Zambia who, as the Principal Nursing Officer (Research), in 1989 initiated a women's project that has become nationally recognized as a model for good community health practices, and she was invited to address the Assembly. This is just one of many examples of strong initiatives made by nurses.

Better health for all and securing equitable health services must guide all change. Nurses certainly can enrich our knowledge about the effectiveness of interventions and health.

Here are some of the specific areas where nurses can help make a difference:

• Demonstrating nursing's role in the care of HIV/AIDS patients and in home care.
  
• Contributing to the evidence base on the role of nurses in community mobilization for integrated health development.
  
• Playing a pivotal role in the Roll Back Malaria and Stop TB initiatives and in safe pregnancy programmes.
  
• As a driving force in the final stretch of polio eradication – just as nurses have always had a major role in immunization programmes worldwide.
  
• Taking the lead on the tobacco initiatives, especially as nurses are active in health education and promoting healthy life styles. Bearing in mind that a large proportion of nurses are smokers, they themselves are an important target group.
  
• Preparing nurses to be ready for emergencies and crisis situations.
  
• Enhancing team building and leadership abilities of nurses as health care providers and planners.
  
• Demonstrating cost-effective care through primary health care and the critical role of nurses in the health care team.

Promoting health-enhancing changes in lifestyle will be crucial. Lifestyle change is difficult to achieve; yet the dramatic decline in smoking in the United States of America over the past generation shows it is possible.

Nurses have many opportunities to play a leadership role in combating the tobacco epidemic. Nurses throughout the world have access to the population at all levels of the health care system, and enjoy a high degree of public trust. Indeed, there are several examples of nurses successfully initiating and implementing tobacco prevention and treatment programmes with specific target populations, such as school children, pregnant women, and people recovering from cardiac diseases and cancer.

ICN has urged nurses to be involved at all levels of tobacco control: prevention, cessation, and policy, encouraging them to be at the forefront of tobacco control at the local, national and international level, building partnerships with other professional and advocacy groups, governmental and non-governmental organizations. It did so last month during the World Health Assembly.

I hope the National Nurses Associations present at this meeting will put into action ICN recommendations. The Framework Convention for Tobacco Control provides nurses' groups with an excellent opportunity to become active participants in the international tobacco control movement, and

to make a significant difference in curbing the tobacco epidemic.

There is also a need to refine and develop our ability to respond to an increasingly diverse set of emergencies and humanitarian crises. We need to be prepared for emergencies so that appropriate care can be quickly mobilized – including the need to support the caregivers in their demanding and stressful work.

Nurses have long demonstrated their ability to be flexible and to rise to new challenges – challenges that arise not only because of a changing world, but also because of varying educational standards and varying regulations of nursing practice.

The information revolution is transforming the world and will inevitably transform the health care system. Emerging information technologies will vastly improve the maintenance and dissemination of medical records, allow treatment outcomes to be measured more systematically, make possible new kinds of health information systems for homes and local communities, and allow us to increasingly customize information systems to improve health.

Building stronger evidence is the key to the success of advocacy. Evidence of nursing interventions that are cost effective and lead to better health will improve our performance in health care.

WHO is looking forward to finding ways in which we can make the most effective contribution to health and development - particularly among poor communities and in a sustainable manner.

WHO recognizes the experience and expertise which nursing and midwifery leaders bring to the development of national and local health policies. Nurses are called upon to face the challenge and participate in the process of health sector reform.

Nursing needs to play the key role in the caring services within the health sector reform programmes in all countries, in one form or another. Nursing needs to respond to the challenge of providing efficient, cost-effective and quality nursing services to meet the longstanding and emerging needs of the population, in particular among the poor and vulnerable.

The International Council of Nurses turns 100. But the image you convey is not one of ageing.

Today, I pay tribute to the youth of this Council.