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