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Honorable Governor,
Mr President,
Ministers,
Dr Alleyne
Excellencies,
Ladies and gentlemen,
It gives me great pleasure to be with you here in San Juan,
thirty-five years after I landed with my fellow students from Harvard
School of Public Health for a one week field trip to the exotic islands
of Puerto Rico. The beauty and serenity of this island belies the fury
with which the natural elements can wreak havoc in this part of the
world. While we can all enjoy our stay here, we should keep in mind the
suffering and the tremendous damage caused by storms like Mitch and his
siblings over the past few years. I would like to congratulate this
Region on the tremendous effort it has made - and the solidarity it has
shown - in building up health systems devastated by these recent and
repeated major hurricanes.
Year 2000 is now only a few months away and the world is taking
stock. We who devote our work to health can celebrate many remarkable
achievements. But there is also a legacy. More than a billion people who
are poor - a substantial number of whom live in this Region - will enter
the next century without having shared in the gains of the health
revolution of the 20th century.
That we have to change. With a combination of vision, commitment,
effective organization, and working together, we can achieve notable
accomplishments in the years ahead. The knowledge which produced the
revolution of past decades can still bring the excluded billion into our
midst.
Mr President,
Today I wish to take the opportunity to share with you how I see the
role of the World Health Organization in this major transition. You know
our mandate and I can assure you of our commitment: We are after a
better deal for world health. A better deal with the prime purpose of
delivering a better, healthier future to all, but especially to the
poor.
As Director-General of WHO, 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. Reaching out to civil society,
NGOs, our UN partners and to the private sector - as we do it in this
Region - increases the impact we can make.
Let me share with you today our assessment of our work with the
American Region, based on four global strategic directions.
First, we have to reduce the burden of excess mortality,
morbidity and disability, especially that suffered by poor and
marginalized populations.
On many fronts, the American Region can stand as an example for hope
and optimism. Through systematic and effective intervention, this Region
has achieved some impressive improvements in health over the past few
years. These improvements show that what often seem like endless fights
against diseases that constantly defeat us can be winnable battles, if
we only take a systematic, result oriented approach to them.
This Region has now been polio-free for five years, a real
inspiration to the countries and regions in the world which still battle
this crippling disease.
Although we have good reasons to celebrate, we must remember that
this is a fragile victory as long as polio still is a problem in other
parts of the world. We will urge countries not to let up on their
surveillance efforts. In a global village where any country can be
reached in less than twenty-four hours, no country is safe from polio
unless all countries are safe.
We may have reason to celebrate another great success and
inspiration, as measles may be eliminated in this Region by next year.
Malaria continues to be a major health problem. In three weeks many
of you will meet in Lima to develop a common strategy to fight malaria
in the Amazon basin. WHO will introduce our Roll Back Malaria Initiative
at this meeting as a framework for the common strategy. We look forward
to this meeting. I am confident it will pave the way towards a reduced
economic, social and health burden of malaria on the population.
Mr President,
Formidable long-term sustained efforts are needed in the global
response to HIV/AIDS. WHO’s commitment is unshakeable. We are
addressing 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.
I am greatly encouraged by the fact that Ministries of Health in
several countries in the Region are providing antiretroviral treatments
free to people living with HIV. These bold initiatives should be widely
applauded.
At the same time intensive negotiations with industry need to
continue to find ways to provide HIV drugs to all patients, irrespective
of where they live and what they can afford to pay. These mechanisms
have to address the three basic strategic objectives, namely:
affordability, reliable health systems and adequate financing.
PAHO’s initiative to start a revolving fund for bulk purchases of
antiretroviral drugs is an additional important option to improve
access.
It is also encouraging to see the strong national Sexually
Transmitted Disease control programmes that have been developed in the
Region. One may consider the elimination of congenital syphilis as a
feasible target for many countries in the Region in the next 5 years.
Two public health interventions need particular attention: The first
is to develop voluntary HIV testing and counselling as an entry point
for HIV prevention, for reduction of mother to child transmission and
for HIV care.
The second intervention is the urgent need to scale
up Sexually Transmitted Infections prevention and care through public
and private outlets.
Even without HIV as its deadly ally, tuberculosis is a major global
threat to health, and demands an urgent and massive response. I have
made the project against TB a priority. Last month, I moved all of WHO’s
TB control efforts under the single umbrella of the Stop TB Initiative.
It will redouble its efforts to bring new partners into the coalition
working to control TB, and aims to double the world wide expenditure on
TB control within three years.
In many countries in this Region, the public sector is increasing
case finding and cure rates for TB. It is the private sector which is
now lagging behind. Since the private sector often dominate health
services for the poorest in many countries, too few people with TB are
receiving proper care. We must bring the private sector and the
voluntary agencies with us if we are going to succeed in our DOTS
strategy. We must all commit ourselves to achieving 100% coverage with
the DOTS, or Directly Observed Treatment Short Course, TB control
strategy by the year 2005.
Mr President,
Progress in Integrated Management of Childhood Illness has been
impressive in the Region, implemented in 19 countries. In Bolivia, the
"Seguro Basico de Salud" includes free attention and treatment
for children with IMCI classifications. This is the first country
anywhere in the world to explicitly include IMCI in a health insurance
scheme.
The Region has been so successful in building a network of skilled
consultants that they are regularly used by other Regions and
Headquarters promoting the exchange of experience across WHO Regions.
This Region has also become a center for IMCI related clinical research
and development of educational material. These are great achievements
which can be used as examples to follow for other regions.
We will intensify our work on reducing maternal
mortality. To push the agenda on reproductive health forward, WHO has
developed a strategy to make pregnancy safer. The Making Pregnancy Safer
Initiative will encourage governments and our international partners to
ensure that safe motherhood is placed high on the political agenda, a
matter of social responsibility and economic good sense.
Immunization remains one of the most cost-effective public health
interventions there is. 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 have agreed to establish a Global Alliance for Vaccines and
Immunization to push for a renewed effort to develop new vaccines and to
help increase immunization rates all over the world. WHO will be
chairing this Alliance in its first two years.
Mr President,
Let me briefly 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 sectors outside the health
sector have a major impact on health. In the environmental field, air
pollution is an ever-growing problem in cities in this Region. For the
tens of millions who crowd into the slums of these mega-cities, the
effects of pollution, crowding and lack of proper sanitation are the
largest threats to their health. Neither health interventions nor
economic growth will on their own solve these problems. It will take
active government intervention - concerted policies towards sustainable
development and vigorous enforcement - before we will see any meaningful
improvements in the overall health situation for the urban poor.
Talking about air pollution - there is another threat that is already
with us in a big way - an emerging epidemic about to hit the developing
world. I am referring to tobacco.
The tobacco industry is conducting a major offensive. It is now
focusing its attention and advertising power on the developing world -
and especially on women and children.
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.
In most countries, as many as nine out of ten addicted smokers say they
started before the age of 18. We are not talking about free choice. We
are talking about a violation of children’s rights.
I am greatly encouraged by the suit launched by the US Justice
Department last week to seek compensation for the huge medical costs
tobacco-related diseases place on federal health care. The way American
states and now the federal government calls a spade a spade is an
inspiration to governments all over the world.
Yet, suing tobacco companies for the damage they cause is not enough.
Strict tobacco advertising legislation and information campaigns are
necessary if we want to reduce smoking prevalence among our populations.
In May, the World Health Assembly endorsed our work to create a WHO
Framework Convention on Tobacco Control. We will welcome representatives
from the Americas at the meeting in Geneva of the working group on the
Convention in a few weeks. I especially welcome the recommendations from
the meeting of the Working Group of Regional Lawmakers, that took place
in Chile a month ago. The three-year plan of action agreed on at this
meeting will help the work on the Framework Convention considerably.
Mr President,
The third strategic focus concerns health systems to which WHO
will give renewed priority.
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.
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.
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 policy.
Countries are 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 to it.
Mr President,
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.
Research illustrates clearly how illness is not only a result of
poverty - but can also cause it. What we are increasingly seeing is that
improved health conditions can turn this vicious circle around.
Healthier, better fed people are more productive and can focus their
resources on improving their livelihood.
Ministers,
You have to face many players in development - and we all are facing
many players in international health. As the lead agency in health with
a 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 budget.
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 where can we call on our collaborating centres?
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 budget.
In too many countries our resources are divided between too many
disparate activities, and there is not enough coordination between our
activities. We are in the process of changing that, and I hope you will
support this process.
Mr President,
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.
You know where I stand: WHO’s most important tasks lie in
countries, and our budgets and joint efforts will reflect this. The
efficiency shifts we have to make in the 2000-2001 budget will not lead
to a reduction in spending at the country level. But throughout WHO, we
can become more efficient.
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 US dollars at this stage, in line with what the
World Health Assembly called for. I would ask for your cooperation as
Ministers when it comes to focusing the funding that this will free up
for priority health areas within your country.
Mr President,
Excellencies,
Ladies and Gentlemen,
This is a Region of extreme contrasts, stretching from Pole to Pole,
both geographically and when it comes to health. Highly equitable health
systems neighbour some of high inequality. Poverty lives next door to
tremendous wealth. Success stories in health abound, but so do failed
policies.
Big or small, rich or poor, together you have achieved remarkable
success. An important reason for this has been the last decade’s
renewed respect for human rights and popular democracy. These two basic
institutions are crucial in improving health and reducing poverty. The
progress over the past few years have proven that only when there is
commitment among the leaders to respect the will and the basic rights of
its people, can real development take place.
This Region has the human and financial resources to eradicate
poverty and create a world where all its citizens enjoy the basic human
rights of health and nourishment. The progress so far makes me
optimistic. I am confident that you will succeed, and WHO stands ready
to support you.
Thank you. |
