Ladies and Gentlemen,
At the eve of the millennium, this Regional Committee meeting is
here in Florence - a formidable symbol of the humanism that lays the
foundation for so much of the progress we have seen over the past five
The Renaissance masters were inspired by the ability of men and
women to do good and create beauty. That must also be our inspiration
as we strive to ensure Health for All into a new century.
Few of the world’s absolute poor live in this Region. Yet poverty
and inequity are major challenges. How do we create equitable health
systems that can reach all? How can we make the major health advances
available for all parts of the population? How can we combat disease
and at the same time promote healthy lifestyles in an increasingly
Europe, home to the inception of the welfare state and universal
coverage, should be at the forefront in the search for these answers -
for the good of the people of this Region and for the good of the rest
of the world.
Today I wish to share with you how I see the role of the World
Health Organization in this major transition.
I have seen it as one of my prime tasks to improve the
effectiveness of our Organization’s work. Working together more
effectively, as one WHO, is key. We - WHO - cannot do everything, but
what we decide to do, we must do well. It goes for all of us. In times
of many conflicting challenges we must all learn to focus on
the health issues that matter most - and we must reach out and
convince our partners to do likewise.
Let me share with you today our assessment of our work with the
European Region, based on four global strategic directions.
First, we have to reduce the burden of excess mortality and
disability, especially among the poor and marginalized populations.
Infectious diseases remain a threat to all of our Regions. Although
we live in a transition towards a greater burden from noncommunicable
diseases, we must never lower our guard against spreading infections.
Here in the European Region, we are developing joint strategic
frameworks for the main categories of communicable diseases.
Gradually this approach is proving to be more efficient. The
anti-diphtheria campaign in the Region has been a success. The
aggressive measures taken in the diphtheria-endemic countries of the
Region have saved thousands of lives. The immunization efforts and the
Region-wide cooperation on surveillance are an example of how WHO can
initiate international action that achieves results no single country
could manage on its own.
Roll Back Malaria is perhaps the most ambitious example of such a
cross-cutting health initiative. Today malaria is on the rise in all
Regions. In the southern parts of the European Region, malaria is
endemic, with an estimated 100 000 cases or more in Tajikistan alone
last year, and at least four other countries being seriously affected.
But even in the north there are cases of malaria, illustrating how
disease now travels at the speed of the most modern means of
We have to roll back malaria. The goal of WHO is to cut
malaria-related mortality by half by the year 2010. We can do so if
existing interventions are used according to available evidence. This
goal can be achieved as health services become more focused on helping
communities tackle priority diseases.
The long-term success of Roll Back Malaria will require better
interventions, new preventive measures and treatments. New alliances
for more effective research and product development, such as the
Multilateral Initiative on Malaria, and the Medicines for Malaria
Venture, are essential to this success.
Public health battles may often seem endless. But right now we may
be very close to eradication of one of the greatest disabling diseases
of humankind. We may be only a few months away from eradicating
Over the past few months, we have seen great progress in the two
largest depositories of polio, southern Asia and central Africa.
Europe has successfully used the strategies of the global eradication
initiative: mass immunization campaigns, mopping up and surveillance.
Only one country in the Region had cases of polio last year and it has
taken effective measures to strengthen immunization and surveillance.
A world free of polio - what a gift to the generations of the next
century! We need a truly global effort if we shall succeed. We must
raise the remaining resources for succeeding the home stretch. We must
go from house to house, from marketplace to marketplace, again and
again, until every single child has felt the drop of the vaccine on
his or her tongue. This is our chance to rid the world of polio.
Contrasting these positive developments is the formidable global
battle against HIV/AIDS.
WHO’s commitment to this battle is unshakeable. Along with UNAIDS
and other partners, we are fighting it on every front, from issues of
blood safety and mother-to-child transmission, to the use of
anti-retroviral treatments and the care of people living with HIV, and
of course, the dual epidemics of HIV and tuberculosis. We will push
for new drugs and eventually the vaccine against HIV. And we will push
for every deal that can make these innovations available for all - not
least on this continent.
It is worrying that we are no longer able to see a decrease in new
HIV infections in Western Europe, at the same time as infection
figures in Eastern Europe and the Newly Independent States continue to
rise at an alarming rate. The Regional Office has strengthened the
action against HIV/AIDS and integrated its activities into other WHO
programmes. Special focus must be put on prevention: through
education, through increased blood safety and through an inclusive and
progressive approach towards high-risk groups.
Blood safety is absolutely key, and a special priority for WHO. I
announce today that WHO will make "Safe Blood for a New
Millennium" the theme for the World Health Day 2000, in April
next year. That will give us a real opportunity to mobilize attention
as well as resources for this critical dimension of public health, and
I count on all of you to make the message heard.
Even without HIV as its deadly ally, tuberculosis is a major global
threat to health, and demands an urgent and massive response. Last
month I moved all of WHO’s TB control efforts under the single
umbrella of the Stop TB Initiative. We will redouble our efforts to
bring new partners into the coalition and we aim to double the world
wide expenditure on TB control within three years.
During the past decade, TB has emerged as perhaps the most serious
infectious threat to adult health in Eastern Europe and central Asia.
Infection rates continue to rise alarmingly. A main reason for this
growth is the economic recession which has increased poverty,
overcrowded prisons and homelessness in the eastern part of the
Region. Yet, we do not have time to wait for the economic climate to
turn to see progress on TB.
We need to think creatively about new technological and health
systems advances in the response to the TB epidemic. Still, we must
fight it with the tools we have. DOTS (Directly Observed Treatment
Short Course) continues to be our central tool. We must all commit
ourselves to achieving 100% coverage with the DOTS TB control strategy
by the year 2005. WHO will make a special effort to support the
priority countries in fully implementing DOTS. We will make a special
focus to tackle the alarming TB rates in prisons in the eastern part
of the Region.
Then there is the area of immunization. Over the last year, the
issue of vaccines and immunization has been reviewed by WHO with the
major partners - UNICEF, the World Bank, bilateral donors, and the
private sector. We need a new concerted push to improve access to
sustainable services, to introduce new cost-effective vaccines and to
accelerate the development of new vaccines, especially against HIV,
Tuberculosis and Malaria.
The leading partners have agreed to establish a Global Alliance for
Vaccines and Immunization. It will be chaired by WHO in its first two
years. We will be ready to present this major undertaking early next
year and it is my hope that the countries of Europe will know the
timeliness of actively supporting this initiative both politically and
Let me move to the second strategic direction. Focusing on
the things that matter does not just mean diseases. There is also the
need to counter potential threats to health that result from
economic crises, unhealthy environments and risky behaviour. We need
to strengthen the focus on how areas outside the health sector have a
major impact on health.
We should be seriously concerned about the increase in adult
mortality rates seen in parts of Eastern Europe over the past few
years. Alcohol abuse, depression, deteriorating nutrition standards
and illness caused by serious environmental degradation have always
burdened these countries’ populations, but they have been greatly
amplified by the rapid social and cultural change and the severe
economic crisis that these countries have experienced over the past
A key message of Health for All is to link sectors of societies in
a common endeavour for healthy lives. Cross-sector activities are key.
From the experience of some countries, for example Finland, we have
seen that public health programmes to prevent noncommunicable diseases
can be highly effective. In Western Europe, campaigns that focus on
lifestyle and risky behaviour have also had substantial results in
reducing morbidity and mortality.
But in many countries, the public health function is weak and
under-prioritized. In many countries, the public health infrastructure
needs to be considerably strengthened. But before this can happen,
there must be a political will and commitment to seeing public health
taking a central role in health care. In the Health 21 Agenda, this
Region has an effective road map for its work ahead.
Europe can pave the way. The conference of environment and health
ministers in London in June showed that nations can reach legally
binding agreements on important issues that stretch across both health
One in seven people in this Region does not have safe water to
drink. The Protocol on Water and Health signed in London will
potentially improve the water safety of 870 million people. No one can
any longer pollute with impunity, and no government can any longer
shrink from its obligation to provide adequate drinking water and
sanitation for its people.
In addition to the air pollution, vehicle accidents kill 120 000
people on European roads each year. This is a challenge to all of us.
The current pattern of road transport in Europe is not sustainable. We
have alternatives, but we need to further explore how these
alternatives will benefit both health and economy. The Charter signed
in London is a step on this road, and I can assure you that WHO will
be active in this field.
Talking about air pollution - there is another threat that is
already with us in a big way. I am referring to tobacco.
Although the number of smokers in Western Europe has been on the
decline over the past two decades, we have over the past few years
seen this decline slow and in some cases having been reversed. I am
sorry, for example, that the figures in my own country Norway show a
considerable increase in consumption among the young, and especially
among young women.
We must renew our efforts. Tough national policies of the 70s and
80s have not been sufficient. A continued campaign to set new
standards and change attitudes must never falter. And, in a globalized
world, we all must stand together to prevent the focused and
consistent attacks on our youth from the tobacco industry.
Young generations are lighting a fuse. The explosion will kill one
out of two smokers and load new, expensive and totally avoidable
burdens on the health sector.
Let’s be frank. Adolescents are being lured into tobacco
addiction. Eight out of ten addicted smokers say they started before
the age of 18. We are no longer talking about free choice. We are
talking about a violation of children’s rights.
Strict tobacco advertising legislation and time-limited information
campaigns are necessary but not enough. We need to keep a constant
global vigil against tobacco. The tobacco industry’s marketing
efforts continue without any pause. And in the formerly restricted
markets in Eastern Europe and the Central Asian Republics, as well as
in the developing world, the tobacco industry is conducting a major
But we are progressing. When I took office, one person in WHO
devoted part of his time to tobacco. During these 13 months, a broad
and talented team is pulling the efforts of WHO and its partners
together. In May, the World Health Assembly endorsed our work to
create a WHO Framework Convention on Tobacco Control. We will welcome
European representatives at the meeting in Geneva of the working group
on the Convention which will take place in a few weeks.
Yet, as Europe is working towards the target of reducing the number
of adult smokers to under 20% of the population by 2015, some continue
to say that such reductions will be bad for the economy because of
lost employment opportunities and tax incomes to the government. They
are making a big mistake. Health is WHO’s business, so we let the
World Bank answer the question on economics: in their latest report
– Curbing the Epidemic - their message is clear: Tobacco is
not only bad for health - it is also bad for the economy.
Let us be vigilant and let us be confident. Tobacco can be fought.
Tobacco will be fought - and all of us here - and many, many more,
will be part of that fight.
The third strategic focus concerns health systems. WHO will
give renewed priority to helping countries develop health systems that
can better respond to present and future challenges.
Building on the impressive achievements of the last half century,
health systems must assure protection for all within - of course -
limits set by available resources. This is the key message of the New
Universalism that WHO spelled out in this year’s World Health
Report. It means in short that we must develop a process of priority
setting which is evidence based, ethically grounded and socially
acceptable. Our best hope lies in a health system that makes the
improvement of health status and the recognition of health
inequalities its defining goal. A health system that responds to the
legitimate needs of the population. A system that protects people from
financial loss due to health care costs and that distributes such
economic burdens fairly.
The challenges that face you who sit here today range widely: some
of you have highly developed welfare states that are under pressure
for reform; others are trying to reconstruct old state-run systems
with drastically insufficient resources. All of you have to take into
consideration a substantial number of the relatively poor, who cannot
be left without basic health coverage.
There will be tough choices: not just in deciding which services
should be covered but in determining how health care should be
financed. Health care has to be paid for - but solidarity through some
form of pre-payment system places less of a burden on the poor than
systems which rely on out-of-pocket payment. A growing body of
evidence suggests that pre-payment is an efficient as well as an
equitable financial policy.
Country after country is now looking to WHO for guidance on health
sector reform. They want to engage us in how to handle the rapid
growth of private medical care and to harness the energies of the
private sector for public goals. We will respond to that call, and we
are considerably expanding our capacity to do that.
We need to be able to understand why one country’s health system
performs better than another. A better understanding - of success,
failure and best practice - needs to underpin the new agenda for
health systems reform. To indicate the importance of this subject, the
whole of the forthcoming World Health Report 2000 is being dedicated
The fourth direction concerns the development agenda itself.
I have pledged to do what I can to place health at the core of that
agenda - where it belongs. Health is key to human development and
What we are increasingly seeing is that improved health conditions
can turn the vicious circle around.
Last May, with the generous contribution from the British
Government and in particular the personal commitment of Secretary of
State Claire Short, WHO convened the leading donors and major
developing countries to a dialogue on how health can be a more
powerful tool for poverty reduction and growth acceleration. We all
agreed that this potential needs more vigorous exploration.
Later this Fall I will appoint a Commission on Macroeconomics and
Health to critically assess the potential for how health investments
can serve as a catalyst in poverty reduction. Inside WHO we are
assessing where the major disease problems of the poor lie and how
cost-effective the related interventions would be. I believe this
knowledge will be of major interest to our Member States and I look
forward to reporting back to you in some months’ time.
As the lead agency in health and with its broad mandate, WHO needs
to refine its role and see how we can best be of use to our Member
States. Let me share with you some of the issues. They will indeed be
brought to your attention as we start planning for the 2002-2003
In each area - be it HIV/AIDS, or making pregnancy safer - we need
to ask ourselves where WHO’s comparative advantage really lies.
Which functions are we best equipped to perform? Which are better left
to other organizations or governments? Or where can we call on our
collaborating centres? They play a key role. We have revised the
procedure for designation and redesignation of collaborating centres,
and the new procedures will be submitted to the Executive Board in
January, next year.
WHO is a technical agency, not a major donor. We also need to think
of ourselves as a catalyst – forging alliances and building
consensus in many different contexts - at national and international
level. This catalytic role lies at the heart of all our core
functions, and will be a dominant theme as we prepare our coming
Focusing means having clearer priorities. That means in turn
stopping some of our current activities, so that we can have a greater
impact where the needs are greatest.
In too many Regions and countries our resources are divided between
too many disparate activities. We are in the process of changing that.
We need to focus more critically on the outputs that our activities -
and those of our partners - result in at a country level. And we need
to place ourselves in a strategic position and go for the
interventions where our impact will make the largest difference.
I would like to conclude with some comments on the World Health
Assembly budget resolution, and the work that is now underway in
response to it. The Assembly decided not to compensate us for cost
increases. And in addition we were asked to shift resources from
so-called low priority areas to high priority areas.
It has been a tough task. But I believe we have found a realistic
way forward, one which avoids cutting our key activities.
In reviewing the options for efficiencies, I have looked first at
measures that are applicable across the whole of WHO. We are
concentrating on cutting our travel bill, for example, and taking a
critical look at what we publish and what we procure. Globally, I have
decided on a figure for efficiency measures of around $50 to $60
million at this stage, in line with what the World Health Assembly
called for. I would ask for your cooperation when it comes to focusing
the funding that this will free up for priority health areas within
Nothing destroys health like war and natural disasters. This
Region still experiences both. Even after the dead are buried and the
wounded treated, one will find that a whole health system is destroyed
which had taken decades to build up. This year, we have seen this
happen in our midst once again, in Kosovo, and recently in the tragic
earthquake in Turkey.
The pledges to rebuild have been made, but the contributions are
slow to materialize. With the expressed moral obligation to take
military action, we certainly must have a moral obligation to help
compensate for the destruction the war caused.
WHO is taking a key role in the work to rebuild the health system
after the war in Kosovo. Our job is to coordinate and structure the
reconstruction of the health system which has been drained of people
and resources. I pay tribute to all the public health workers who have
committed to the health and well being of so many suffering people. I
pay tribute to the dedicated WHO staff in the field who play a crucial
role in close cooperation with our sister agencies and many NGOs. This
is the way it should be. We are a technical agency. We work best when
we can use our technical expertise and our advice to influence the
policies and work of governments, civil society and other agencies.
One such example is donation of drugs. Good drug donations help
save lives and are very much needed, especially in times of emergency.
But inappropriate and unneeded donations have overloaded distribution
systems and hampered relief efforts. In many crisis situations 15%,
30%, and in some cases up to 60% of drugs donations were inappropriate
because they were expired, inadequately labelled, or simply unknown to
local health providers. We have revised the guidelines and we are
working with industry, governments and NGOs to achieve the best
Ladies and Gentlemen,
Let me end by extending our appreciation and gratitude to Dr Asvall
for his long and dedicated contribution to the World Health
Organization - above all by leading the European Region through so
many changes - but also in Africa. In the history of the Health for
All movement, Dr Asvall will always have a central place.
Europe has a lot on its plate. But Europe, which is home to many of
the wealthiest nations in the world, must not let the conflicts and
problems in its own Region take attention away from the billion poor
who are struggling to achieve a minimum of what most of us take for
granted. The major battles for health worldwide are fought in the
slums and the countryside of our 50 or so least developed countries.
Their fight is also ours.
In a globalized world, where disease travels as fast as capital
does around the globe, there is no such thing as a localised health
problem. Malaria, tuberculosis, the five child killers and maternal
health are also challenges for those who live in the world’s richest
In the world of the next century, our futures are tied together. As
long as one fifth of the population is excluded from basic health,
none of us can say we have succeeded. So let us turn the tide together
and mobilize for a better future - a future where there will finally
be Health for All.