It is a great pleasure and honour for me to be here
For all of us here tonight, our health is vitally
important. We have the same feelings for our families and others
closest to us. We are not exceptional. People, all over the world,
value good health almost above all else.
There is increasing recognition by key decision
makers - in government, in the private sector and in civil society -
that healthy communities and societies are vital for the future
development of nations and of our planet. Simply put, investing in
health used to be seen as a luxury, to follow investing in energy, in
transport or in defence. Now the health of a society is seen as one of
the first pre-requisites for the development of its people.
Taken together, the facts tell us that differences
in people's life expectancy and well-being are one of the most vivid
signs of the divisions in our world. They are also one of the main
causes of this divide.
Today, the role of people's health has a central
place in global debate.
When we talk about global trade, we cannot ignore
the issues of access to life-saving medicines and technology at
When we talk about human security in our modern
world, the global spread of diseases such as malaria, tuberculosis and
HIV/AIDS form an important threat.
When we talk about the frontiers of technology and
science, advances with potential impacts on health are dominating the
When we talk about the environment, we worry about
the consequences for our health of unsafe food and lifestyles, of
pollution and of global warming.
Health is no longer an expenditure only the rich
countries can afford. It is a necessary investment by the poorest
countries of this world. I want to say to you tonight that this is an
investment we cannot leave to these countries to shoulder on their
own. The partnerships we build to share the burden are alliances that
will serve our common future.
A world in which only a privileged few have access
to the fruits of the technological revolution is a world which will
become ever more insecure. In the past, desperate conditions on
another continent might cynically be written out of one’s memory.
The process of globalization has already made such an option
In the modern world, bacteria and viruses travel
almost as fast as money. With globalization, a single microbial sea
washes all of humankind. There are no health sanctuaries. As we have
seen from the devastation brought about by HIV/AIDS, and the easy
spread of diseases such as TB, Rift Valley Fever and West Nile fever,
infectious diseases are biological weapons without a master.
The separation between domestic and international
health problems is no longer useful. Millions of people cross
international borders every single day. A tenth of humanity each year.
Infectious diseases kill 10 million people each year. Almost all of
these are among the poorest three billion. In 1998, communicable
diseases were responsible for about a third of the total burden of
disease world-wide. In poorer countries they make up almost twice that
It is not only the infectious diseases that spread
with globalization. Changes in lifestyle and diet prompt an increase
in heart disease, diabetes and cancer.
More than anything, tobacco is sweeping the globe
as it is criss-crossed by market forces. Only weeks after the old
socialist economies in Europe and Asia opened up to Western goods and
capital, camels and cowboys began to appear on buildings and
billboards. Four million die now from tobacco-related diseases. Unless
we act, in the not too distant future ten million will die each year
from tobacco related causes. And all this additional burden will hit
mostly developing countries.
Diseases - particularly HIV/AIDS, TB and malaria -
are themselves major causes of poverty. The success or failure of our
collective response is critical. It holds the key to the economic and
physical security - not just of individuals and communities - but of
nations and continents.
Last year I set up the WHO Commission on
Macroeconomics and Health. This will provide solid evidence for future
action, based on sound economic analysis. The Commission has already
assembled some powerful data. Quite simply, the devastating effect of
ill health on the economic prospects of the world's poor communities
has been under-estimated. Massively so.
HIV prevalence rates of 10-15% - which are no
longer uncommon - can translate into a reduction in growth rate of GDP
per capita of up to 1% per year. TB, which is made worse by HIV, takes
an economic toll equivalent to $ 12 billion dollars from the incomes
of poor communities.
Africa's GDP would probably be about $ 100 billion
more now if malaria had been tackled 30 years ago, when effective
control measures first became available.
There is no way the poorest countries will be able
to achieve sustained economic development until we manage to stop the
haemorrhage of people dying from HIV/AIDS, malaria and TB.
Ladies and Gentlemen,
We have the tools to make a difference. A number of
health interventions can dramatically reduce mortality from the main
killers. Supervised medication regimes for TB; nets impregnated with
insecticide against mosquitoes, and wide distribution of malaria
treatment among children and pregnant women; prevention programmes for
HIV/AIDS - or access to care programmes that can substantially slow
the mortality among those living with HIV. There are many more
interventions, proven to be effective on a local or national level.
If we can make these interventions available to
those who need them, we will start to see dramatic reductions in
levels of poverty. Results can be measured and demonstrated.
No matter where they are - in Rio, in Lusaka, in
Mumbai or Moscow - people living with HIV know that now there are
drugs available which can effectively prolong their lives. They can
read news articles describing what they are called and how they work.
And they know that only the most privileged among them can afford to
buy them. This widespread knowledge, a consequence in part of
globalization, radically changes the social and economic context in
which these drugs are developed and sold.
Two weeks ago, I joined the Secretary-General and
Peter Piot of UNAIDS for a meeting with the CEOs and presidents of six
of the world's leading pharmaceutical companies. We brought forward
discussions that were initiated a year ago on how to further reduce
the prices of key drugs and diagnostics needed to fight AIDS in
Last week, in Norway, the World Trade Organization
and WHO together with the Norwegian Government and the US-based Global
Health Council, hosted a unique meeting where representatives from the
research-based pharmaceutical companies, from the generics industry,
from developing countries, from the United States and the European
Union, and AIDS activists sat down around a table together, for the
first time. We worked together not on whether, but on how we can bring
cheaper medicines to poor countries.
A year ago, I was in Nigeria with most of Africa's
heads of state who met to discuss how they could reduce the burden of
malaria. Next week African heads of state will meet once more, this
time in the presence of the Secretary-General to discuss action
In my discussions with presidents and prime
ministers from Indonesia to Mexico, from Congo to Pakistan, health has
stood out as a central concern. Questions that used to keep only
health ministers awake at night are now also on the minds of
presidents and finance ministers.
Leaders of industrialized countries have addressed
the realities that when people die from AIDS or malaria in Africa, it
is also their business. More than eighty years ago, my fellow
countryman, the explorer and humanist Fridtjof Nansen, told to the
victorious powers after the First World War that "charity is
Realpolitik". Today, we would probably speak about
"enlightened self interest", but the point is the same.
The United States signalled this when it last year
declared HIV/AIDS as a national security issue. The G8 leaders last
July subscribed to targets to halve the burden from malaria and TB
within ten years and reduce HIV infections by 25%. The European Union
has formulated a plan of action towards this goal.
The key to driving back illnesses that cause
poverty is straightforward: invest more, and invest it well.
WHO estimates that no country can offer an
effective basic healthcare to its population without spending at least
$ 60 per person per year on health. Yet, most countries that suffer
from widespread malaria, HIV/AIDS and other infectious diseases have
less than $ 15 dollars per person per year to spend on health.
I recently heard the Minister of Health from
Malawi, describing how changes in the value of the local currency had
reduced planned government spending on drugs this year from $ 1.25 to
just 75 cents per head. Compare that with prices of antiretroviral
drugs for AIDS care. Even with the new offers from pharmaceutical
companies, these drugs cost nearly $ 1,000 per patient per year.
Many developing countries can and must change their
spending priorities. But even when countries do their utmost, the bulk
of the money needed to see a massive scaling up in the fight against
diseases must come from the rich countries.
How much? We estimate that to reach agreed targets
for malaria in Africa will require an additional 1 billion dollars a
year. For TB, around half a billion dollars per year in the twenty-two
high-burden countries. For HIV/AIDS the gap is even larger - probably
in the order of 3 billion dollars for expanded prevention and
support in Africa alone. Add in the use of antiretroviral drugs and
you can double the total figure.
In short, we are talking about an additional annual
investment of $ 10 billion per year for at least fifteen years. If
that sounds a lot, it equals 0.04% of the combined GDP of the
industrialized nations - the same nations which have pledged to spend
0.7% of their GDP on development assistance, but in recent years have
reduced it to an average of less than 0.2%.
There have been many ideas about ways to collect
and use new funds that need to become available for health. Based on
experience, there are some important principles.
- It should quickly bring both cash and commodities to where they
can directly contribute to better health.
- It should provide resources for measurable outcomes: the level
of support being linked to their achievements of those outcomes.
- It should improve health systems so that they become effective
and are seen to work well.
- Decisions in relation to programme and policy options should be
based at county level.
- There should be a key focus on processes and outputs that
- Developing countries must be involved in governance, operation
We must act now. If we wait another decade,
HIV/AIDS will have engulfed China, India, large parts of the states
that make up the former Soviet Union, and Eastern Europe – dwarfing
the scale of the current epidemic in Africa. Drug-resistant TB may
have become as widespread as ordinary TB, making treatment of this
disease as expensive as antiretroviral therapy. Other medicines may
also have lost their potency due to growing drug-resistant strains.
There is a process of mutual reinforcement from the
scaling up of our work on key diseases and the building up of health
systems. As health systems are strengthened and capacity increases, we
need to widen the task towards other health priorities, such as the
growing burden of noncommunicable diseases and mental illness, and the
high level of injuries.
We are talking about a fundamental break from
"business as usual".
Governments cannot do this alone. We are all
responsible. The private sector and civil society must play a crucial
role if we are to succeed. New partnerships will be formed;
partnerships that are driven by enlightened self interest.
Recent examples of such collaboration include the
Global Alliance for Vaccines and Immunization or the ventures put
together to fund development of new drugs for malaria and
tuberculosis. They are characterised by open governance, identified
functions, clear criteria for disbursement, accountability and a
capacity to deliver.
WHO, as the UN's specialized agency for health, has
a central role to play in setting up, managing and ensuring their
When I first took up my position in WHO nearly
three years ago, I stressed that WHO, like the UN system as a whole
must define its relative strengths and advantages. What we don't do
best, we should leave to others.
What WHO can and should do is to provide the
evidence of what works and what doesn't, and how we can best measure
outcomes. Through the credibility given by our expertise and the
weight of the Member States, we give a stamp of quality and approval
to interventions that we know will make a difference.
This vital work is highlighted through the
declaration at the UN's Millennium Assembly. It is much more than good
resolutions for the new century. For me it is the UN's new
job-description - our corporate strategy and mission statement rolled
into one, under the inspired leadership of Kofi Annan.
In the century just behind us, the UN was able to
play a role in the struggle to free the world from tyranny and
authoritarianism. This century, the UN, working closely with our
Member States, is poised to play a central role in the struggle to
reduce poverty and promote peace and prosperity.
The UN has a critical role to play in promoting and
sustaining the movement to improve global health. It is at the centre
of our mandate. Our ability to succeed will be a tangible sign of UN
reform in action.
Let me assure you, our work with new partners is
sharpening our senses. We are kept on our toes by sharp thinking
economists, street-fighting activists and ever-questioning corporate
heads such as Ted Turner, and Bill Gates. We need to pursue
excellence and cannot afford to be slow or disjointed.
You have in this country some outstanding
institutions, which are pillars in meeting the new international
challenges as they are tackling the national agenda. The National
Institutes of Health and the Centers for Disease Control and
Prevention are a truly global resource and we in WHO are honoured to
work with them in close partnership. The UNA-USA campaign in the field
of global health is another strong sign of partnership.
Ladies and Gentlemen,
This is a time when only excellence will do:
anything else will fail those whom we serve. We are taking up this
challenge. With your help, and the involvement of the people and
institutions in this country, we can build a force that will fulfil
the hopes and aspirations of people the world over.