Mr Chairman,
Commissioners, Ambassadors
Ladies and Gentlemen,

It gives me great pleasure to welcome you today to the third meeting of the Commission for Macroeconomics and Health.

First, let me thank Thorvald Moe in his absence, and indeed Donald Johnston and his staff for hosting this meeting. And let me add a special welcome to the representatives from OECD delegations. Your presence here today sends a clear signal about the significance of this exercise.

As you know, I am no stranger to the work of international commissions. I know all too well that you, the Commissioners, and your Chairman have a difficult and complex task. But it is a task of very great importance indeed.

Placing health at the heart of the development agenda. This is the purpose of the Commission, and the theme of what I want to talk to you about this afternoon.

Seventeen years ago I was asked to chair the World Commission on Environment and Development. In the earliest stages of planning, I realized that we had to blaze a new trail. Our task was not just to set out facts – though good science was crucial. What we had to do was to establish a new way of thinking about the environment. A new way of thinking that would be accepted not just by activists – but by governments in the north and in the south, and by development agencies all over the world. That was no small job at a time when work on the environment was based on a policy which could be best described as clean-up-after-the-damage. Our goal was to make sure that the environment was no longer an afterthought, but at the leading edge of development policy.

Now it is time to turn the spotlight on health – particularly the health of poor people. The task that I have asked you to take on – simply put – is to help us change the way the world thinks about health and development.

As your chairman has said in the opening lines of the interim report, you will be considering this week that "the public health crisis in the world’s poorest countries poses one of the great challenges facing the world today". In my view, it is the greatest challenge.

The evidence you are beginning to amass tells the story clearly.

Infectious diseases alone account for 13 million deaths a year. A new epidemic of noncommunicable diseases is also well under way in the developing world – made worse by the ravages of tobacco. In sub-Saharan Africa life expectancy at birth, which rose to 59 years in the early 1990s is set to drop to just 45 between 2005 and 2010. The situation is worse in those countries most severely affected by the HIV/AIDS epidemic, where an existing burden of infectious disease is compounded by an epidemic which has outstripped all projections. These countries act as a window on the future. They show what will happen unless urgent action is taken in those parts of the world where the epidemic is still emerging.

Among the 10.5 million children who died last year, 99% were from developing countries. Over 50% of these deaths are due to just five infectious diseases, made more deadly through malnutrition. Two million people a year die from TB – and 99% of these deaths are in the developing world. Deaths from malaria continue to rise in many parts of the world. In Africa – where 90% of cases occur – 700,000 children will die from malaria this year. That is one every 30 seconds.

The heads of state that met in Okinawa this summer did not exaggerate when they talked about how ill health has the power to reverse decades of development, and to rob an entire generation of hope for a better future. We need sustained action and coherent international co-operation to break the vicious cycle of disease and poverty.

Reversing current trends. Restoring health. Securing health and prosperity for those living in poverty. That is our challenge. That is what lies at the heart of our work in WHO, and of course, at the heart of the work of the Commission.

So let me now turn to the Commission itself.

Some people may think that addressing the health needs of poor people and poor communities is a task for technical experts and public health physicians. In part that is true. But one thing I have learnt over the years is that to reach the minds of those who hold sway over real financial and political power, we – and I speak now as a health professional – have to communicate in a language that these decision makers understand. Good health is intrinsically important in its own right. But we cannot ignore the fact that governments will take more notice when faced with robust evidence showing the true economic impact of avoidable illness. This information also has to be presented in such a way that it stands out amongst all the other information and choices that governments face every day. So while good health needs a technical response, it certainly needs a political response.

I am convinced that the full economic cost of communicable diseases has been under-estimated. For example, recent studies suggest that in countries in which 10-15% of the population are HIV positive, this can translate into a reduction in growth rate of GDP per capita of up to 1% per year. What would Africa’s economies be like now if malaria had been effectively controlled 30 years ago.

Think too about the $12 billion dollars that could accrue to poor communities if they were no longer threatened by untreated TB.

That poverty causes ill health is well known. But good health can fuel the engine of development. Healthy people add significant momentum to the forces of economic development and poverty reduction. This is the case we have to make.

Which is why the CMH includes some of the world’s leading economic thinkers. People to whom policy makers turn when they need advice – not just about individual sectors of the economy – but about the bigger picture. Also among your number are policy makers with experience at the very highest levels of government. You know how governments work, what kind of information they need to make decisions. You also need good technical advice, which is why the Commission and its working groups include some of the best public health people around. Putting all these skills together – the technical, the economic and the political – the Commission can be a powerful force for change – advancing the cause of health and development.

I would like to highlight some of the challenges facing the Commission as it enters an intensive phase of its work. But before I do, let me say a few words about how I see the political environment in which we are working. Understanding this environment is critical to us in WHO, and it has influenced our strategic thinking.

There is a growing consensus among political leaders in all parts of the world that action to confront the development crisis posed by ill health is urgently needed. The UN Millennium Summit, the International AIDS conference in Durban, the Malaria Summit in Abuja, and at the meeting of Health and Finance Ministers on TB in Amsterdam – at all these events heads of state from developing and developed countries called for a step increase in our response to the diseases most closely linked to peoples’ poverty. The two debates in the UN Security Council show the political, economic and social dimensions of the HIV/AIDS epidemic. All the events I have mentioned have increased the support for a number of global partnerships: Roll Back Malaria, Stop TB, the Global Alliance for Vaccines and Immunization, the campaign to eradicate Polio, and the International Partnership against AIDS in Africa.

International agencies have begun to respond to the call. In direct response to the Okinawa Communiqué, the European Commission has announced support for accelerated action against malaria, HIV/AIDS and TB in the context of poverty reduction at a recent international round table in Brussels. The World Bank is exploring more flexible approaches to funding work on communicable diseases, including HIV/AIDS. UNICEF is working on a New Global Agenda for Children in preparation for the 10-year review of the goals of the World Summit for Children.

There is no doubt about it: the context in which we are working has changed within an very short time. And things continue to move at great speed. In May this year, five pharmaceutical companies approached WHO and UNAIDS to initiate a tentative dialogue about increasing peoples access to life-saving patented drugs to combat HIV/AIDS and opportunistic infections – largely through reducing prices. Just six months later, we have the prospect of the European Commission taking on a leadership role and providing a forum in which countries north and south can explore a much wider range of strategies that could dramatically increase the affordability of essential drugs.

As the leading technical agency in health, WHO has a responsibility to respond to the calls of the international community, and to signpost the way forward. What will it take to scale up the response to the most serious health problems affecting the poor? The short-hand we have used in WHO when we refer to this work is the Massive Effort. For this is what it will take. We know now that we cannot expect to reach the targets endorsed in Okinawa or, indeed, the other international development targets, if we just continue with business as usual. The scale of the problem means being prepared to revisit basic assumptions.

Centrally stands the question of resources. Whatever way we calculate it, there is a huge gap between what is needed and what is currently available. Countries cannot reduce malaria or TB deaths by half with current levels of spending. We know there is not enough money now. But to make the case for more, we need robust and defensible estimates of what is needed, and how it can best be used.

And it is not just calculations about the absolute amounts that are required. We must be prepared to look closely at the role of development finance in national health budgets. What should donors finance and how? How can the savings from debt relief – that countries need so badly – best be utilized?

Secondly, we must be clear about priorities – and focus on the health conditions that most affect poor peoples’ well-being.

We must be clear about what works – identifying the most effective health strategies in different settings.

We must use all effective channels to ensure that poor people have better access to the services, the commodities and the information they need. This means good government stewardship: to get the best out of the public sector, and to fully harness the energies of private, voluntary and community organizations.

We need independent systems for monitoring progress.

We need to work through nationally driven development processes to ensure that health plays an increasingly prominent role in national poverty reduction strategies, and that sector wide approaches focus on better health outcomes.

Increasingly, we need to link work at country level with enabling actions globally. In today’s world, we can no longer see these two domains as being separate. The success of national programmes depends on many local factors, but also on international policies which influence the price of essential pharmaceuticals, and the incentives which govern research and development world-wide. Globalization – as it affects the flow of products, people, services and information – must be made to work for the poor.

Mr Chairman,

As we set out this agenda, the role of the Commission for Macroeconomics and Health becomes increasingly clear. Setting out, and endorsing the quality of the evidence that will help the international community and national governments to act more effectively in the interests of poor people. Analysts and advocates: your role is to help us turn intention into action.

In fulfilling this role over the coming months, I foresee a number of challenges:

Given the increasing prominence that health has had on the international agenda, it might be tempting to think that we are now pushing against an open door – that everyone accepts the importance of investments in health. Tempting perhaps, but unwise. We have to marshal the facts in the most clear and convincing way possible. Robust evidence, solid facts – are not only essential in the short term, but are key to sustaining the political momentum that has begun. There is still a lot of convincing left to do. On the international scene, for sure. And even more so at country level. On my travels I meet an increasing number of enlightened heads of state and finance ministers – but I am only too aware that there are many, many more to win over.

Over the next few days you will be thinking about the main messages of the report. Your chairman, and the co-chairs of several of the working groups, have taken the first steps by putting initial ideas on the table. These ideas now need to be debated vigorously by the Commission as a whole. No doubt there will be differences of opinion as to what the main focus should be. This is inevitable and healthy, and I would not expect anything less from such a diverse group. There are also difficult choices to be made, given the breadth of the subject matter. I do hope, however, that by the end of this meeting you will have reached a consensus – among all the Commissioners here – about the main thrust of the report that we will see in a year’s time. And – that you will have identified a few key points for in-depth discussion amongst you. Clearly, you need to be sure you see eye to eye on key points in the analysis.

The substantive content of the report is obviously the most critical aspect of your work here, but it is important not to overlook the importance of also getting the process right. This is true within the Commission itself: how do we get those members involved who are unable to be with us today, for example? Getting the process right is going to be equally important when it comes to some of the key constituencies that the Commission’s report will address. I will be interested, for example, to hear how you plan to ensure that governments in the South are fully engaged in your thinking. What will be the best way of presenting the ideas of the Commission to groups in civil society – before they are finally published? How can we make sure that we bring the main donors along with us? These are all issues that we grappled with in the World Commission on Environment and Development and I look forward to debating them with you whilst we are together here in Paris.

Consultation is going to be important before the content of the report is finalized. When it is finished – this time next year – the dissemination process will start. In my experience, there is a need to place as much emphasis on disseminating the report as upon drawing it up in the first place.

All of us recognize that funds for development work are scarce. We are all being asked to show that what we do represents good value for money. The Commission, of course, is no exception. The challenge is to make it clear to all concerned how your work adds value to the efforts of other institutions. What can you do, that others cannot? As I see it, the strength of the Commission lies not in doing a great deal of new scientific work. Your comparative advantage must be in drawing ideas together from a number of existing sources and presenting them in fresh and clear ways. Above all, the task is to convince other decision makers and opinion formers like yourselves – people who are not necessarily familiar with the world of health and development – that this is an area which deserves their urgent attention.

Finally, let me return for a moment to the changing context in which we are working. You know there is a growing interest in looking at new and better ways of managing development assistance. National governments and international agencies are seeking new and better mechanisms. New ways of doing business. In thinking through these issues, it seems to me that the first and fundamental rule is that development must be country driven. New mechanisms – whether they be for channelling funds, supporting research, or procuring essential commodities – must support and strengthen national systems and national institutions. Good science and rigorous review is critical, and will play a role in decision making by governments and their development partners. National governments must have all the information they need to help them decide between competing priorities – within and between sectors. Providing this information is our task. Making the tough decisions on the basis of that information is theirs.

Mr Chairman, Ladies and Gentlemen,

These are exciting times. We live in a rapidly changing world. And we have an opportunity – greater perhaps than has been granted to any other generation in history – to make certain that those changes are for the good. Changes that will make the world a more healthy and a more equitable place to live. I have convened the Commission on Macroeconomics and Health to help us make the case that good health is not just a good in its own right, but one of the most powerful development strategies at our disposal.

I am impressed by the progress you have made in your work already. And I look forward to the debate and discussion over the next two days.