Geneva,
13 December 1999

Looking Back at 1999 :
Monthly Briefing for Missions

I welcome representatives from the Missions to this final briefing of this year – and without stretching the event too far – the last briefing of the century.

Let me first say how much we have appreciated these monthly gatherings with the Permanent Missions in Geneva. I have been pleased to see so much interest in our work. At the outset I realized that there were much fewer occasions for exchange between the Missions and WHO compared to the exchanges that you have with many other UN agencies.

That has its natural explanation in our governing structure. When I took office, I believed that we needed to increase the interchange with the Missions and thus with the Member States on a more regular basis. This I continue to believe – and even more so – I believe we need to consider additional mechanisms for strengthening this dialogue.

It is true that WHO is a specialized agency with a broad network and with a wide range of professionals in countries. This will need to continue and even to be expanded as we are seeking to further increase the quality of our relationship with the collaborating centres.

But beyond this network, I am conscious of the broader political implications of our work. Health is a dimension of societal and political development which stretches beyond the bio-medical sphere right into the core of the global political agenda for development. So we need more exchange with broader spheres of political decision-making in Member States, and thus we need more intimate relations with the permanent representations here in Geneva.

I hope we can revert to this next year. We are reflecting on some ideas for how this can be done within our present institutional arrangements. And we will be seeking your advice on how we can tailor the involvement of Missions in a way which is mutually beneficial to us all.

For today’s session we have not chosen one single theme. Instead, I wanted to share with you a retrospective calendar of 1999 – selecting one or two highlights for every month that we have behind us – and at the end I would like to look ahead towards some of the key events awaiting us as we enter a new year.

In selecting the highlights, I have had in mind some of the main directions that I introduced when I took office – and I have tried to use these events to illustrate how we have been working to pursue them. They include:

• Restoring a credible priority-setting mechanism based on solid evidence
• Put a stronger focus on the health of the poor
• Work to anchor health on the global agenda
• And reach out to new and old partners in order to enhance what we can do together.

Going back to January 1999, I begin with the Executive Board – the first one under the new administration, with the presentation of a new Programme Budget for 2000-2001 and the opportunity to reshape the agenda in a more political direction.

The EB meeting is an important event. I felt that the presentation we made on the way ahead for our work and the presentation on trends and challenges for world health triggered a different atmosphere in the Board. I recall a week of good discussion – and of course a lot of learning by us.

The budget was well received in its form. We stressed at that time that the proposal was indeed work in progress. But a new shape was there, shorter and more focused on expected outputs, and a better reflection of how the Organization can work as a whole.

A main theme was of course my pledge for zero real growth. I will not repeat that debate which was very vivid until the World Health Assembly in May. The Assembly voted a budget with zero nominal growth. But the end result was somewhere in between with the special allocation of the US$15 million from casual income to priority areas.

I believe the debate we had then was the beginning and not the end of a very crucial discussion for the UN as a whole. Do Member States really want to install an eternal principle of zero nominal growth? With some time perspective we all see where that will take us – to the gradual transformation and dilution of the entire UN system. I sense a renewed debate on this issue – pointing towards a more differentiated approach – acknowledging that one can make exceptions and reward agencies that perform well and give priority to areas which indeed represent global priorities.

We are now in the starting phase of the budget for 2002-2003. That will be yet another reformed budget where we will take forward our effort to plan and budget for One WHO – be clearer about our priorities based on evidence and opportunities for making change to the better – even more focused and with solid procedures for monitoring and evaluation.

In February, I joined Ministers from more than 180 nations gathered at The Hague to evaluate the progress made in the five years since the 1994 International Conference on Population and Development in Cairo.

Cairo was a crossroads. It caused a paradigm shift from population control to reproductive health and rights. A lot has happened since 1994, but there is still a long way to go.

In the so called Cairo plus 5 I stressed that a broader understanding of reproductive health is gaining ground. Reproductive health deals with intimate and highly valued aspects of our lives. There are fewer taboos and better understanding about the needs and rights of women to information, to control over their reproductive lives and to a minimum standard of health care which will reduce the risk of disease and death during pregnancy and childbirth.

I stressed that WHO will give priority to two areas in the follow up of Cairo: An increased focus on adolescent health – and a determined effort to help sustain real gains in maternal health. We have launched a priority initiative to Make Pregnancy Safer. In October, we issued a joint statement together with UNICEF, UNFPA and the World Bank on priority actions aimed at reducing the number of women who will die from pregnancy and childbirth. We are also working to improve the information given to young people to enable them to make healthy choices on reproductive health.

From March I have selected our participation in World Meteorological Day – as an example of closer interaction with a sister agency – and an example of how WHO has to look beyond the health sector to help deal effectively with threats to human health.

The environment is indeed one such case – and the theme for the day in March was Climate change. It is a critical issue as we all know – in a world where we can predict tomorrow’s weather but not the climate of the next decade. We have evidence to state that climate change - by altering weather patterns and by disturbing life-supporting natural systems and processes - affects the health of human populations.

We know enough to take this very seriously and we have every reason to be concerned about adverse consequences for human health. The trend of global warming, if continued, will have profound consequences for life on Earth and for the health of human beings.

So WHO has to do its part in studying effects, starting to prepare for better advice to Member States and help build a knowledge base in this critical area.

In April, I visited three countries in Africa: Mozambique, Zimbabwe and Côte d’Ivoire. I paid special attention to our work to start implementing Roll Back Malaria – I studied our efforts to help health systems cope with the HIV/AIDS epidemic and I took part in National Immunization days against polio.

Africa is living through a profound public health crisis with the spread and generalisation of the HIV/AIDS epidemic and the bouncing back of other killer diseases such as malaria and tuberculosis.

But what I saw was also impressive and uplifting. From the highest levels of government to the local health centre, I sensed a commitment to improving health that was heartening and inspiring. I saw a willingness to break down traditional barriers to progress. I saw a determination to succeed.

Today I wish to underline what was my main message during this trip: A story of remarkable African achievement is all too often ignored against the reporting of daunting health challenges. Before the AIDS epidemic began to erode the health gains made through decades of hard work, infant mortality had been significantly reduced in many countries. Against powerful odds, Africa has demonstrated that the tides of ill-health can be turned.

I went to Africa to pay tribute to the tremendous efforts that are being made by health workers under difficult conditions.

Yet, the losses and suffering caused by HIV/AIDS and several infectious diseases are appalling and tragic. Africa will remain a key priority for WHO. Roll Back Malaria is being initiated in Africa. Three of the five countries with which we will start working on debt relief and health strengthening are African: Tanzania, Uganda and Mozambique. Last week in New York I took part in the launch of the Partnership against HIV/AIDS in Africa, and we will be strengthening our regional and country capacity to support African governments in their work to improve health levels for their people.

May is the month of the Assembly. But let me also mention the meeting I had in London with the leading donors just before the Assembly. The purpose of the meeting, which was generously co-hosted by the British Government, was to start a joint exploration of how investing in health can make a tangible difference for health, development, and in particular for poverty reduction.

This has been a central theme of our work all of this year and it will continue to be key in the year to come.

We are committed to play our role in reaching the development target of halving the number of people living in poverty by 2015. There is mounting evidence that targeted health interventions aimed at improving the health of the poor can reap real development gains. WHO was asked to pursue this agenda and come back with expanded evidence on these causal links.

We have worked hard to follow up the London meeting – and we are now calling the next meeting on a technical level in March/April. At that meeting we will present new evidence on the cost-effectiveness of such interventions – we will present a first version of a set of core interventions particularly aimed at making a difference for the poor.

The Health Assembly is the pulse of WHO. I wanted the Assembly to be more political and less ritual. The address of Professor Amartya Sen will be remembered for the new visions he shared with us – the way in which he put health into a broader context. So will the round tables of ministers – a first attempt at allowing a freer exchange of experiences and views among political leaders. We will build on these experiences at the next Assembly – trying to make the meetings even more directly useful for the participants.

In June, London was the venue for the Third Ministerial Conference on Environment and Health. The European region has made tangible progress in the areas of health and environment. This third conference of its kind concluded by adopting a joint protocol on Water and Health to ensure adequate sanitation, to ensure adequate supplies of wholesome drinking-water, to protect water resources, and to safeguard human health against water-related disease. They also adopted the Charter on Transport, Environment and Health, confirming commitment to make transport sustainable to health and the environment.

The London conference was successful in placing environment and health issues high on the political agenda of governments, non-governmental and international organizations, as well as at local level. It has been successful in bringing together key players from a broad spectrum of disciplines. It was a real inspiration for concerted action for health and the environment in the context of sustainable development. Some of the European trans-national agreements and cooperation can stand as an example for other parts of the world.

July was marked by the follow-up of the World Health Assembly’s budget resolution. I am proud of the way my staff throughout the Organization responded to the guidelines we sent out immediately after the Assembly. Talking to you at the end of this year, I can say that we have made the necessary decisions to deliver on the recommendations of the budget resolutions. Cost increases at around US$25 million will be absorbed, and we have agreed on how. Shifts from low to high priority areas of another US$25 million has been identified and agreed.

One feature of this exercise was the invitation to staff to signal interest in Mutually Agreed Separations – whereby they obtain a lump sum compensation which would be somewhat higher than their normal leaving payment. We were able to do this because our special fund earmarked for making these payments had scope for such an exercise at this time. 331 staff throughout the Organization applied – and last Friday I agreed to 224 separations, that were in the interests of the Organization. It was clear from the beginning that this was not a staff right, but an opportunity for the Organization as a whole.

This exercise allows us to do two things: First - we are saving money – we estimate that the reduction of staff numbers will save us more than 19 million dollars. The money we save will be directed to high priority areas. Second – in some cases we will now be able to recruit new staff with a new set of skills adapted to our present needs.

The follow up of the budget resolution has required a major effort – and I have put emphasis on making it an effort for all parts of the Organization. It started well with the first meeting of the Global Cabinet in July where I gather the Regional Directors – and this time also all the Executive Directors and the Directors of Programme Management in the Regional Offices for a two-day retreat. This was an important and fruitful event to help us move towards One WHO.

The shifts and cost absorption that you are now seeing are a result of a unified approach – and that is – I believe – new in WHO. It was important for the settlement of this budget - but it may prove even more important for the elaboration of the next one. As I said, in that budget we want more joint programming, more joint planning and more joint budgeting by an Organization working as one entity.

By August, the fighting had stopped in Kosovo and hundreds of thousands of refugees prepared to pour back into the province. While the military campaign lasted, WHO had played a coordinating and monitoring role in the refugee camps of the Former Yugoslav Republic of Macedonia and Albania as well as being part of a UN mission which attempted to assess the environmental effects of the war in Yugoslavia.

After the peace settlement, and after the TV crews had left the battle fields, WHO returned with the first UN humanitarian convoy. It was time for the painful reconstruction phase of a health system severely demolished, not only by the hostilities but by years of strain. WHO has re-established substantial humanitarian operations focused on public health presence and surveillance, support to the local Institute of Public Health, hospital and primary health care management; a range of public health programmes; together with health care policy, planning and financing.

In addition, under the terms of UN Resolution 1244, WHO is working closely with the United Nations Mission in Kosovo, or UNMIK, which has been established to provide an interim Government. A WHO staff member, Dr Hannu Vuori, has been appointed to the post of "Health Commissioner". WHO is taking a primary role in both the maintenance and promotion of the public health and the management of the existing health services in Kosovo, as well as in the planning and development of new structures.

WHO has taken a similarly active coordinating role later in the year in East Timor, when the time had come for yet another painful process of reconstruction.

September is a month of marathon travelling for the Director-General – shuttling around the world to cover meetings in six regions. I made them all - except for the meeting in the Western Pacific in Macao, as the typhoon ravaging Hong Kong forced me to spend a day in Bangkok. I regret that I missed this important meeting but at the same time I benefited from spending several hours with our field staff in Thailand, listening to their views and experiences.

My main message to each of the Regional Committees was to introduce them to our work towards a corporate strategy. I presented the four strategic directions that will underpin this strategy, namely:

• Reducing the burden of excess mortality and disability, especially in poor and marginalized populations
• Reducing risk factors associated with major causes of disease
• Developing health systems that equitably improve health outcomes
• Promoting an effective health dimension to social, economic, environmental and development policy - in short, placing health at the core of the global agenda.

I explained how all our work should be related to these four directions – the way we plan our activities and the way we allocate our resources.

I also stressed the need for us to be more strategic in our work at a country level – where frankly it matters most. And I stressed that we have to consider what WHO offers in advice and technical cooperation as a contribution to real health outputs – our performance cannot be judged on the basis of the financial input. That input will remain very marginal, and our common challenge is to spend it in a way which enables us – the country representative with the whole of WHO supporting her to make the largest contributions.

In some cases the scarce WHO money is seen to be filling gaps in national expenditure schemes. While I understand the sometimes desperate financial situation of many health ministries in developing countries, I truly believe we can make more of a contribution to sustainable health development by not spreading these resources over too many dispersed programme areas.

In October, we had the first technical meeting to begin the drafting of the Framework Convention on Tobacco Control. It is the first time in its 50-year existence that the World Health Organization is exercising its constitutional mandate to negotiate a legally binding treaty. More than 90 per cent of the world population was represented at that first round of official talks.

When ready, the Framework Convention will give the world a new instrument with which to address and steer the global health debate. It will be a invaluable tool for governments in their efforts to limit and reduce the damage tobacco does to the health of their populations. The process itself is an inspiration for change.

We have come far in only 18 months. When I took office less than one man-year was devoted to tobacco control. Now there are 15 dedicated people with a broad global network at work week after week. The World Health Assembly gave the mandate and the direction: Tobacco exporting and importing countries, surveying the death and destruction caused by tobacco on their people, their economies and their environment, called for accelerated work to begin on the Framework Convention. Their message was this: take action so that the global spread of tobacco is circumscribed. Take action so that the number of tobacco deaths can be brought down.

October’s meeting was the first concrete step towards accomplishing this. The work is continuing as we speak.

In November, I went to Beijing to launch WHO’s new, global strategy for mental health, an area I pointed out as a priority for me as Director-General when I took office.

The evidence tells us how mental problems make up a major part of the global burden of disease. It is likely to become even heavier in the coming decades and will raise serious social and economic obstacles to global development unless substantive action is taken. And this is a neglected cluster of disease and suffering in rich and poor countries alike. WHO has to show its leadership in bringing this onto the political agenda in its full dimension.

Our new strategy focuses on four areas of action:

• The first is to raise the priority given to mental health in most public health agendas.
• The second is to reduce stigma and discrimination towards persons with mental disorders.
• The third is to overcome the traditional centralization of mental health services, resulting in large, ineffective and often harmful psychiatric institutions providing the main source of treatment.
• And finally we will improve the knowledge about cost-effective mental health treatment, prevention and promotion strategies and to disseminate this knowledge widely.

These are not expensive or technically complicated interventions, and when done right, they can substantially reduce the existing burden of mental disorders, especially in developing countries, where otherwise the main future growth in mental problems will take place. This will both reduce suffering and save resources for other health challenges. The launch’s positive reception in Beijing augurs well for its future success.

This brings me to the end of the year and to December. The events of Seattle stand out. WHO was there as an observer, following the events and liasing with Member States.

WTO is still in the process of assessing the lessons learned from Seattle. I believe all of the UN has to study how the effects of globalization affect our mandates in this era of globalisation. Trade is indeed not an isolated issue – it touches all spheres of society.

I believe that there is not sufficient contact between the UN agencies on these issues. During the negotiations in Seattle, I wrote to Mike Moore offering that WHO would be ready to chair a working group on access to drugs and medicines. This was a controversial issue at Seattle – and we can be helpful in bringing the partners together to move the issue forward.

I also believe that UN agencies have too little contact on the relationship between trade and social issues. I have invited colleagues from WTO and other Geneva agencies pre-occupied with social issues to an informal reflection on these issues in January.

At WHO in December we have had a joint meting of UNICEF, UNFPA and WHO with representatives of our governing bodies to assess our joint efforts in the areas of child and maternal health.

We have marked World AIDS Day, devoted to the critical role of youth and adolescents.

A week ago I was in New York to support the Secretary-General in his launch of the Partnership against AIDS in Africa – and I attended the meeting of the UNDG – for the first time since WHO joined this coordination group of the United Nation’s field activities.

These were some highlights from the last 12 months – highlights from a busy, rewarding, challenging and diversified year with my staff and many, many colleagues and partners of WHO.

I feel we have moved the agenda forward. I am frequently consulting the pledges I made when the World Health Assembly elected me in May 1998 and I feel that we have made progress. We restructured quite profoundly during the first 6 months – 1999 has been a year of consolidation but at the same time continued change of working methods, planning and monitoring of our work – especially with an emphasis on more coherent working together with regions and countries.

We have made progress, but we are well aware that there is still a way to go – there will always be in an Organization like ours. But we approach them with enthusiasm and dedication to move the agenda, our working methods and our partnerships forward.

Looking ahead – let me briefly share with you some of the expectations for the coming six months:

First thing in January year I will be on a plane to New Delhi to kick off the last intensive phase of the polio eradication campaign – and to attend a conference on tobacco and legislation. I see these two issues as topical for the work we are pursuing;

• On the one hand - in the year 2000, we may successfully draw a line in the sand and say that finally we managed to eradicate another crippling disease. I say may succeed because the end game will be critical and we are still short of funds.
• And on the other hand we are stepping up our work to confront an epidemic of the 21^st century – that of tobacco. Two very different challenges – but with very detrimental effects on human health.

Then there is the Board meeting – and you will all have seen the agenda. I believe this will be an intense session focused on important strategic issues for WHO – including our corporate strategy and strategic choices in our work on poverty.

In my address to the Board I will lay out the main themes of the corporate strategy and give an indication of priorities for the next budget – and then invite the Board to share their reflections with us.

In February, I would emphasise the launch of GAVI – the Global Alliance on Vaccines and Immunization. We presented GAVI to you in November. The official launch with UNICEF, the World Bank, representatives of industry and Mr Bill Gates will take place at the Annual Meeting of the World Economic Forum. This is one year after the Secretary-General launched his appeal for creative private-public partnerships – and I believe we are able to present just that on a critical theme for global public health; to provide vaccination to the children of the world is among the most cost-effective and critical interventions we know of.

In March I look forward to attending the Ministerial Conference on Stop TB in the Hague – a major effort to raise awareness on the spreading Tuberculosis epidemic. In 1993, WHO called the spread of Tuberculosis a global emergency. Still the epidemic is spreading in the footprints of misery and under-development. We know what works – we know where to invest – but we are lacking the resources to go to scale. The conference, co-hosted by WHO and the World Bank, will convene ministers from the countries hardest hit.

In short the messages of the conference will be:

1. TB IS MUCH MORE THAN A HEALTH CONCERN: TB is a social, economic and political issue.

2. ACCESS TO DRUGS IS ACCESS TO OPPORTUNITIES: Life-saving drugs get people back to work, school and their families.

3. ACT NOW, TOMORROW IS TOO LATE: The risk is a drug-resistant epidemic with massive social and economic costs.

April will have the ACC Meeting of the Secretary-General and the heads of agencies in Rome, and thereafter the Global Cabinet of WHO, the Director-General’s meeting with the Regional Directors, will convene in Washington, in the Regional Office of the Americas.

Let me also mention World Health Day on 7 April – which next year will be devoted to Safe Blood. For the first time WHO is opening up to another partner - the Red Cross and Red Crescent Federation - as a co-host of that day.

Right after Easter I will travel to Nigeria for a planned meeting of African Heads of State who have responded to President Obasanjo’s invitation to a Summit on Roll Back Malaria. The Roll Back Malaria partnership is moving ahead at full speed and the main area of activity now is on country implementation – and I very much welcome the initiative by President Obasanjo.

You know that I have defined Roll Back Malaria a pathfinder. When I was elected it was my ambition that the way this project would work would lend useful experiences for the way we work to control and roll back other diseases. I believe we are starting to harvest very useful lessons on the way to work with our partners with no bureaucracy and promising efficiency – the way we link with the private sector to develop new drugs and the way we start to reach communities and involve partners beyond the health sector.

May is again the month of the Health Assembly and we are currently working to prepare an agenda which will respond to the expectation of a highly relevant and useful session of work for the health ministers of our Member States.

In June I am planning to travel to Mexico for the International Conference on Health Promotion, we are preparing for our attendance at the conferences marking Beijing plus 5 and Copenhagen plus Five – and in July I plan to take part in the International AIDS conference in Durban, South Africa.

WHO will further increase its work on HIV/AIDS in the next year. We will have to work along the same lines as we have defined with partners and in this regard support to the health sector response is a key component for WHO. At the same time we need to innovate and look for new approaches. From 1 January WHO will be taking over the coordinating work on a HIV/AIDS vaccine from UNAIDS. The whole issue of access to drugs under the international trade agreements remains an issue of complexity and urgency and we will need to address it with all the creativeness that we can mobilize – alone and with many of our partners, including with industry.

There is – as you can see – a lot on our plate. In this century WHO has been making a difference for the health of the people of the world. We see our mandate as continuing serving our Member States and their populations to address old and new challenges to their health and development opportunities.

Thank you.