Mr President, ministers, distinguished delegates,
ladies and gentlemen,
For years we have all been striving to get health
in its proper place.
All of us in this hall know that health for all is
vital for human security.
Now, advocacy for health has moved beyond circles
of health professionals.
Prime Ministers and Presidents, rock singers and
sports’ stars, business leaders, share our position.
Put simply – unless people are healthy, we
will not see economic growth; we will not see stability; we will not
see human dignity, or fulfilment of human rights; we will not be at
I do not mean that health is everything. But most
of the world’s leaders now recognize that good health is essential
for the secure future of our planet.
They have agreed on a set of development goals for
the millennium. Many of these goals are concerned with health. The
Commission on Macroeconomics and Health has presented them with a road
map for how these health goals can be achieved.
At the Monterrey Conference on Financing for
Development, several of them agreed to scale up their investments in
achieving the Millennium Development Goals. A growing portion of such
investment is being earmarked for health.
This increased emphasis is much needed and most
welcome. And we should not be too modest. We have all been
instrumental in making this happen.
The dreams that inspire us at the World Health
Assembly, our calls for action and our carefully crafted
resolutions – all of this has a broader meaning. We have
triggered a change. Now we are taking it forward. A hearty welcome to
you all. I would like to specially greet the Minister of Health of
Afghanistan, Dr S. Sediq, who is with us here today. That our
colleague is a woman is all the more welcome and itself an encouraging
sign that Afghanistan is on its way to recovery.
In a world where we tend to focus on shocking
inequities and crises, let us not forget what has been achieved in the
last few years.
- We are well down the road to poliomyelitis eradication with a
dramatic reduction in the number of cases over the last year;
- We have agreed targets – and clear strategies –
for confronting AIDS, tuberculosis and malaria;
- We are seeing a real increase in available resources through a
new global fund to fight these conditions;
- Millions more children are being vaccinated against common
childhood illnesses, and immunization coverage is increasing;
- Mental illness is now being addressed as a major cause of
suffering and disability;
- Nations are united in initiatives to control tobacco marketing
and reduce its use, the forthcoming soccer world cup is smoke
free, many countries have banned cigarette advertising, and many
more have increased tobacco taxes; and
- All over our world, these results are being achieved by
under-funded health systems, often through joint efforts by the
public sector and civil society.
I salute the thousands of dedicated health workers
who have made these achievements possible. All of you here today have
built on these achievements and worked hard to make health a real
development issue. Your work enables me and my WHO colleagues to speak
out – confidently – and call for greater investments. I
Now is the time to chart the way ahead for the next
few years. As I reflect on the increased public interest in health,
three big challenges stand out.
First: we need to speak out about the threats of
ill-health in different societies and the potential for tackling them.
Systematic work on "risks to health" is vital: it will be
the focus of our discussions at this Assembly.
Second: we need to invest in better health systems
everywhere – bringing benefits to those who need them,
responding to needs and expectations, and fairly financed.
And, third: we must sustain the momentum in the
fight against diseases of poverty, empowering affected
communities – and countries – to take action for health
We cannot speak out about risks to health unless we
know clearly what they are. This year’s world health report on risks
to health, to be published in October, will be a wake up call to the
global community. It represents an intensive effort by WHO –
one of the largest projects it has ever undertaken. It tries to
quantify some of the most important risks to health, and to assess the
cost-effectiveness of measures to reduce them. The ultimate goal is to
help governments of all countries lower these risks, and raise the
healthy life expectancy of their populations.
The picture that is taking shape from the research
on the report gives an intriguing – and alarming – insight into
current causes of disease and death and the factors underlying them.
It shows how human behaviour is changing around the world, and the
impact of these changes on people’s health.
At one end of the risk factor scale lies poverty,
undernutrition, unsafe sex, unsafe water, poor sanitation and hygiene,
iron deficiency and indoor smoke from solid fuels. These are among the
10 leading causes of disease. All are much more commonly found in the
very poorest countries and communities.
At the other end of the scale we see unhealthy
High blood pressure and high blood cholesterol,
strongly linked to cardiovascular and cerebrovascular diseases, are
also closely related to excessive consumption of fatty, sugary and
salty foods. They become even more dangerous when combined with the
deadly forces of tobacco and excessive alcohol consumption. Obesity, a
result of unhealthy consumption, is itself a serious health risk.
All of these factors – blood pressure,
cholesterol, tobacco, alcohol and obesity, and the diseases linked to
them are well known to wealthy societies. They dominate in all middle-
and upper-income countries. The real drama is that they are becoming
more prevalent in developing communities, where they create a double
burden on top of the infectious diseases that always have afflicted
The world is living dangerously:
- either because it has little choice,
- or because it is making wrong choices.
Let me put it another way. Six billion people
co-existing on our fragile planet. On the one side are the millions
who are dangerously short of the food, water and security they need to
live. On the other side are the millions who suffer because they use
too much. All of them face high risks of ill-health.
Unhealthy choices are not the exclusive preserve of
industrialized nations. They have consequences for global security and
individual destiny everywhere. We all need to confront them.
In order to improve world health, we all have to
tune up our policies for managing risks of ill-health. Countries need
to be able to adapt these policies to their needs. We know that risks
like unsafe sex and tobacco consumption will increase global deaths
substantially in the next few decades. They will continue to do so
until they are brought under better control.
Individual behaviour is frequently governed by the
circumstances in which people live and work. It influences their level
of exposure to individual risk factors.
We have effective means to reduce these risks. The
critical question is: How do we implement these measures on a wide
scale and ensure better health outcomes?
We must never forget what lies behind the figures
and statistics. Every day, every hour and every minute, a fellow human
being is suffering, and approaching an early death. Families are
coming to terms with tragedy. We have to respond in ways that reflect
the realities of people’s lives. This calls for concerted and
evidence-based action. WHO’s mandate is to get the evidence right
and to see to it that the world uses this evidence to become a
Our first priority must be the children and the
young. They are particularly vulnerable to physical and emotional
risks. Two-thirds of all diseases in later life can be traced back to
behaviour patterns established during the teenage years or to
exposures to health threatening environments in childhood.
I learned about ways to turn evidence into action
when working as an environment minister and then Prime Minister 15
years ago. The evidence must be clearly presented in ways that make
sense to policy-makers. Our Commission on Environment and Development
did this, spelling out the risks to our environment, and the
consequences of neglecting them. Then we had to make sure that they
themselves communicated the evidence and acted on it. That called for
several years of consensus building – by the leaders
themselves. That is what happened at the Rio summit in 1992.
Over the last few weeks I have reviewed the
evidence on risks to health caused by indoor smoke pollution,
environmental tobacco smoke, lead in gasoline, and unclean water. All
these hazards endanger the health of children. The world health
report will show us the human cost. Millions are disabled, and
hundreds of thousands die needlessly. We can prevent all these deaths.
I have seen how ministers of health and environment want to tackle the
risks, save lives and promote child development.
So, when I attend the World Summit for Sustainable
Development in Johannesburg in September, I shall launch a new
initiative to promote healthy environments for children. It
will bring a range of national and international actors together, and
provide back-up for evidence-based action at the community level.
I shall also reinvigorate WHO’s work on diet,
food safety and human nutrition – linking basic research
with efforts to tackle specific nutrient deficiencies in populations
and the promotion of good health through optimal diets –
particularly in countries undergoing rapid nutritional transition. We
have come a long way in developing new guidelines for healthy eating.
When these are complete I shall invite the key players in the food
industry to work with WHO in addressing the rising incidence of
obesity, diabetes and vascular diseases in developing countries.
We also have an immediate, safe and reliable remedy
for some of the major health risks linked to unhealthy consumption. It
is free. It works for rich and poor, for men and women, for young and
It is physical activity. At least 30 minutes each
This is why I chose "Move for Health"
as the theme for this year’s World Health Day. I spent it in Brazil,
witnessing an impressive mass movement for "movement". It is
an example many countries can learn from. The gains, in terms of the
number of chronic diseases prevented, will be huge.
We know that most people will choose to adopt
healthier behaviours – especially when they receive accurate
information from authorities they trust, and when they are supported
through sensible laws, good health promotion programmes and vigorous
public debate. We have seen in the global movement for tobacco control
that transparency and disclosure are the keys to success. Promoting
trustworthiness is the key. This requires long-term vision and
step-by-step action. Some countries – such as South Africa,
Brazil and Thailand – can proudly point to reductions in
WHO has been intimately involved in the
tobacco-free movement. We have created the environment within which
governments are negotiating a framework convention for tobacco
control. We are committed to seeing the process through. Success will
bring benefits to millions of people: they will be healthier and live
longer. We have seen many countries strengthen their national tobacco
control policies: but many are still not doing enough. I urge all
Member States to redouble their efforts before our deadline of a
completed convention at this Health Assembly next year. For the sake
of future generations we cannot afford complacency.
On alcohol, we are much further behind. New data to
be released in The world health report, show that the burden of
alcohol on mortality and morbidity has significantly increased since
Alcohol, like tobacco and other risk factors, is
widely marketed – particularly to young people.
This does undermine health. Turn on the TV, open a
newspaper or magazine, visit a store or market. In just about any
country you will see that children and youth are the targets of the
new technologies of persuasion. Getting loyalty to brand names is the
key to influencing consumer behaviour – from the time children
start to walk. Children currently influence 45% of household purchases
in the United States of America and 65% in urban China.
Brand name promotions – whether for tobacco,
alcohol or fast foods – are designed to take advantage of
people’s subconscious. They use messages which influence behaviour
through their emotional appeal.
These marketing approaches matter for public
health. They influence our own – and in particular our children’s –
patterns of behaviour. Given that they are designed to succeed, they
have serious consequences. We need to work on healthy messages that
promote healthy lifestyles and healthy products. There is certainly a
need for guidance: in some cases, like tobacco advertising and alcohol
advertising aimed at the young, what we need is control.
WHO will play its part.
We provide an umbrella of authoritative positions
under which many others can act for health. This includes speaking out
against tobacco use and confronting all forms of and discrimination
linked to mental disorders, leprosy or other stigmatizing conditions.
It means calling for policies to improve access to
essential health care for all; urging pharmaceutical companies to
reform their pricing structures and to invest more in drugs to treat
AIDS, malaria and other infectious diseases; urging a fair and
innovative use of new knowledge in the field of genomics so that
developing countries benefit on an equal footing with industrialized
That is why our own advocacy must always be rooted
in our evidence base; in our bank of scientific knowledge. In the
past, few paid attention to our work to develop recommendations. Now
advocates for health – whether outside or within government – see
their importance. There is widespread interest in our recent
recommendations for the treatment of people affected by AIDS in
resource-poor settings. This has been reported as a breakthrough in
the effort to reach the six million people who need it.
The need for good evidence is reflected in the
continuous vigilance that must protect the quality of the food people
eat, permit the early detection of infectious diseases and help the
world respond to dangerous pathogens – particularly those
resistant to modern medicines. The evidence should also be used to
make healthy food the choice that is easy – and attractive.
Collecting and presenting such evidence are core
tasks for WHO. We will expand this work.
Let me turn to the challenges of health systems. I
know from my own experience as a politician that if we do not have the
ability to measure how systems perform, we cannot implement policies
properly, and meet the requirements expected of us. Without the data
we cannot adjust the systems and improve results. Establishing
systematic methods for assessing health systems’ performance has
been one of my key concerns over the past four years. The work was
pioneered in 2000 and has now been subject to rigorous review. I
salute the staff who are working on this within WHO, and the thousands
of people within countries who are putting together the evidence base
for it to be revised and taken forward.
Demands on health systems are ever increasing. Care
for acute conditions, such as malaria and injuries, as well as for
pregnant women, delivering and caring for newborns – is
Much more attention is also being paid to
accessible care for longer-term conditions. Tuberculosis treatment.
Care for people with HIV. Therapy for those with noncommunicable
illnesses – including mental illness, epilepsy, cardiovascular
disease, cancer and disabilities.
Wherever I go I see – first hand –
the difficulties being faced. Resources for health are always scarce.
Dedicated health workers are achieving miracles, frequently with
minimal pay. Often they succeed by going outside the traditional
structures; through joint efforts with nongovernmental organizations
and private entities.
But health ministers are always subject to
criticism. That is why I want us to provide them with better methods
for examining health system coverage and quality, based on the new
world health survey.
Health systems need to make the best use of
available funds. So I have established a new initiative to provide
guidance on health care financing in different settings.
Health systems also need people with expertise. I
have also established an initiative to improve human resources in
national health systems. This has many facets: one is the damage
to the health systems which serve poor communities by the relentless
recruitment of skilled nurses – and other health
personnel – to places where the pay is better. The initiative
will also examine options for developing stewardship and technical
skills within the health professions.
When we speak of a health system, we imply a
functioning organization overseen by a competent health ministry.
Countries in crises usually have health systems too, but often they
have broken down.
People caught up in conflicts and crises need
humanitarian help. But they also need the basic infrastructure of
life – essential water supplies, sanitation, health care, food
and personal security.
Women, children and men suffer terribly as a result
of their being caught up in other people’s conflicts. It is
cruel – and unjust – when they are deliberately
targeted; when they are deprived of what is essential for their
Intentional attacks against innocent civilians, as
they go about their daily lives, can never be justified, no matter
what the political or military context. I condemn such attacks,
wherever they occur. Imagine the anxiety of a mother as she searches
for loved ones in the ruins of what used to be her village. Imagine a
father’s anxiety as he puts his child on the school bus and wonders
whether he will ever see her again.
Within any conflict, there are fundamental elements
of a people’s existence, including the ability to maintain its
health, that must be respected. The respect for the neutrality of
health staff needs to be upheld by all sides at all times. I want to
stress – clearly, to all: restrictions should never be imposed
on the movements of medical staff, patients, medicines, ambulances and
other goods. Military operations should never target the
infrastructure necessary for water and electricity supplies, or waste
The current crisis in the Palestinian territories
shows us the impact of what happens if the health system – and
the rest of the infrastructure needed for life – breaks down as
a result of conflict. The Assembly will be debating this and will be
anxious to know our analysis of the health situation.
WHO has managed to get some medical supplies into
the Palestinian territories, and we are currently working to get more
across from Jordan where it is now pre-positioned. But that is not
enough. The health system in the territories must start functioning
again, as soon as possible.
Let me add the voice of public health in support of
all who are urging all parties in the current conflict to move towards
peace and away from confrontation. Israel and the Palestinian
territories are now zones where people suffer mental and physical
ill-health as a result of military conflict. The spiral of violence
must be turned.
During the coming years WHO will give added
emphasis to taking exceptional action for health in emergency
and crisis situations, throughout the world. We will assemble
information on health situations and responses, work in synergy with
all concerned partners, and join them in improving access to essential
health commodities, equipment and personnel. At all times we will help
coordinate an effective response by all involved. This, Madam
Minister, is the role we seek to perform in Afghanistan.
In this hall, in 1998, I said that only a broad
alliance can manage the critical task of bringing the 1.2 billion
people who live on less than a dollar a day out of poverty. I said WHO
must be the health component of that alliance – impatient and
ready to fight for the health needs of poor people. We should lead
when required, and seek to make a difference.
Now, four years later, I feel WHO has fully taken
on that role. We are a growing force in the global effort to improve
people’s lives. We are reaching towards the millions who have been
excluded from this century’s health revolution.
We have helped to focus international attention on
what this really involves – in terms of political commitments
and new resources.
WHO set up the Commission on Macroeconomics and
Health to get world class practitioners and scholars to analyse the
degree to which people’s ill-health impacts on human and economic
development. Jeff Sachs, the Commission’s Chair, will be with
us this week.
Their analyses have aroused much interest and
debate among people who – until now – have not been
focused on international health. Now they want action to reduce this
drain on world development.
The position we are in today is approaching what we
envisaged when we first spoke of the need for a "Massive
Effort", three years ago.
We have seen considerable movement. Summits setting
goals for AIDS action, to Roll Back Malaria, to Stop TB, to improve
child health. Partnerships to tackle AIDS, malaria and tuberculosis,
improve access to medicines, tackle epilepsy and unsafe motherhood.
Also to vaccinate children, develop new medicines, prevent chronic
diseases, reduce malnutrition, tackle influenza and eliminate leprosy
and filariasis. There are new funding mechanisms – such as the
Vaccine Fund, the TB Fund, and the Global Fund to Fight AIDS,
Tuberculosis and Malaria.
We have introduced an integral approach towards
reducing the suffering from HIV/AIDS, malaria and tuberculosis through
programmes that combine prevention, diagnostics, treatment and care.
We are better able, now, to fight for more resources to tackle these
devastating conditions. We have moved a long way towards making
essential medicines accessible to a much larger number than we could
have envisaged only three years ago. But it is not enough. We need
continued reduction in prices of medicines and other commodities, and
expansion of quality services to the millions in need. We must scale
up our effort even if the struggle seems beset with political and
The Global Alliance for Vaccines and Immunization
is a great innovation. It has shown what can be done. In several
countries, vaccine coverage figures have already started to rise –
by as much as 8% in some cases. I salute the people who work
tirelessly to make children’s immunization a reality: whether they
maintain the cold chain, keep vaccine-carrying vehicles running,
encourage children to come for their jabs, mobilize financial
resources, keep partnerships going, and handle the paperwork that
enables the money to move. If all the 74 countries that have
engaged with GAVI meet the targets they have set (and I believe many
of them will) they will have saved two million lives annually. Every
life saved is a real victory – a triumph for us all.
Communities, governments, activists, donors and private entities all
share the credit.
We must press on.
We must further increase the funding for tackling
the illnesses of poverty. The "absorption capacity" of
countries far outstrips donor capacity.
We must increase the number of people who can
access treatments, like antiretrovirals, at the same time as we scale
up prevention programmes. This means rolling out diagnostics and
treatment schemes in a way that broadens access while being equitable,
fair and realistic.
We must improve our ability to measure the impact
of interventions on poor people’s health. We need to know how we
are progressing towards our goals. We must know what is working and
fine tune our programmes.
We must also do all we can to increase access to
essential medicines and health technologies. Participants in last
years’ WTO meeting in Doha supported the differential pricing of
essential medicines, and encouraged flexible interpretation of TRIPS
with a view to enhancing access to essential medicines. Further work
will be undertaken this year: I know that several ministers of health
have asked for WHO to help with this process.
New funds, antiretroviral care, measuring impact
and better access to essential medicines are all challenges for Member
States and for WHO.
So we will improve our capacity to work with
countries, to help them interface both with the new funds and with
other global initiatives. We will strengthen our backing for the Roll
Back Malaria, Stop TB and AIDS partnerships, particularly within
countries. We will support national and global initiatives to improve
maternal and children’s health, and reduce the impact of mental
illness, injury, sleeping sickness and other health conditions on poor
societies. At all times we will pay attention to the ways in which
people’s gender influence their health. Gender concerns must be
infused in all our efforts.
In a world filled with complex health problems, WHO
cannot solve them alone. Governments cannot solve them alone.
Nongovernmental organizations, the private sector and Foundations
cannot solve them alone. Only through new partnerships can we make a
difference. And the evidence shows we are. Whether we like it or not,
we are dependent on the partners, the resources and the energy
necessary for at least a 30-fold scale up in effort – to bridge
the gap and achieve health for all.
It is because we are reaching out, as I said when I
started in 1998 – that we are all succeeding, on so many
fronts. We will engage more partners, build stronger movements and
move beyond the health sector, for one reason only. Why? To pursue
health for all, achieving real impacts among the world’s poorest
I should add that in every joint venture we seek to
define what each partner can bring to the relationship. We identify
where potential conflicts of interest may limit certain types of
interaction. We aim to play to each others’ comparative advantages.
All of this has required WHO to strengthen its work on ensuring
transparency in the affiliations of all special interests, on ethics
and on our internal oversight mechanisms.
What matters most, is the extent to which the
people of the world’s poor nations achieve better health. For WHO a
crucial question is always "How can we best help the achievement
of sustained and equitable health gains in countries?".
We must subject everything we do to the
"women, men and country" test. Will it make a difference?
How much? What else could achieve a better result? That means being
self-critical. Taking account of the enormous demands on national
institutions and capacities. The constraints they face –
notably limited human and financial resources.
There is strong support for scaling up WHO’s
focus on countries – from inside and outside WHO. Through the country
focus initiative we are intensifying action while doing our best
to ensure the development of capacities within countries as well as
within WHO country teams.
It has been a long 12 months since we last met in
this hall. Over the course of these 12 months, the context for our
work has changed.
As world leaders have struggled to chart a course
towards a more stable, secure and peaceful world, they have agreed the
importance of reducing poverty, suffering and inequity.
They see, now, how instability and inequity in one
place, or affecting one community, threatens the whole world. They see
how global action against health risks in one country can help protect
all people in all countries; and that efforts to tackle stigma and
denial have to work at home at the same time as they are promoted
abroad. We have far to go to respond to these imperatives.
The health-for-all concept, the Millennium
Development Goals, World Health Assembly resolutions, our corporate
strategy and now the report of the CMH, the Monterrey Consensus, the
outcome of the Madrid ageing summit and the UNGASS declarations on
children (last week) and AIDS (last year) are there to guide us. These
road maps remind us that we are fighting against poverty and inequity,
that the world’s goals are ambitious, that there is a huge shortage
of available resources, and that all of us committed to change must
work together. Nothing can be sustained unless the people of poor
nations want it, and their leaders act on this desire when they make
decisions about how resources are to be used.
In Johannesburg, this coming September, I hope to
see different national leaders working with civil society in concerted
efforts to invest in people for their sustained development. This is
the only viable route to the long-term future of our planet. It means
continuing with our massive effort to fight the health conditions
which most affect poor people, with ever stronger alliances and
partnerships, and a relentless focus on long-term results.
We have a full agenda ahead of us.
Forging real change is never easy. You have to
confront established ways of thinking and working. But if you are
convinced, as I am, that the change is essential for our shared
purpose, then there is no opportunity to yield to short-term pressures
because this would be the more comfortable way to go. I have never
seen real change happen easily. Never in history was equity achieved
without a battle.
We must continue to build the momentum to fight the
diseases of poverty.
We must build new alliances and new initiatives to
address the risks to health that threaten the essential requirements
for a healthy life.