Speech by His Excellency Mr. Maumoon Abdul Gayoom, President of the Republic of Maldives at the Fifty-eighth World Health Assembly
Madam President, Elena Salgado, the Director-General of the World Health Organization, Dr. Lee Jong-wook, Distinguished Delegates, Ladies and Gentlemen:
I would like, first of all to congratulate you, Madam President, on your election to preside over the Fifty-eighth World Health Assembly, and to wish you success in your important assignment.
I would like also to thank the Director-General of WHO, Dr. Lee Jong-wook, for inviting me to address this session of the World Health Assembly. It is indeed a great privilege, which I deeply appreciate. I had the pleasure of receiving Dr. Lee in Male’ last year. His commitment and dedication to the aims and goals of WHO is indeed praiseworthy.
Before I proceed further, I note that Mr. Bill Gates is scheduled to speak after me. I understand that his foundation has committed more than US$ 3.6 billion in global health grants to organizations across the world, including the WHO. I am sure that I am echoing the sentiments of all of you in expressing our deep appreciation to Mr. Gates and to his foundation for their great contribution to the cause of providing better healthcare worldwide.
Madam President, Distinguished Delegates:
I want to speak to you on some matters of deep concern to my country, the Maldives, and to the world.
Sitting in this palatial meeting hall situated in the centre of this historic city of Geneva, surrounded by such a breath-taking panorama of natural beauty, it may be difficult for us to visualise the enormity and magnitude of natural disasters and other overwhelming problems that millions of people have to cope with in many parts of the world.
Imagine a bright sunny day, on a small tropical island that rises no more than one metre from the mean sea-level. Children are playing on the beaches. Most of the able-bodied are out at sea fishing, or at work somewhere on the island. All of a sudden, and without warning, the sea swells to some four metres, and crashes through the whole island. Within a matter of minutes, the waters recede as the tsunami rips through the Indian Ocean. In its wake, loved ones go missing, never ever to be seen alive again, the whole island is turned into rubble, and the entire community is left in shock.
That was what happened in the Maldives on 26 December 2004.
One-third of the population was directly affected, many of whom lost their livelihoods, and some 5% of the nation was internally displaced. Nearly two decades of development and some 62% of the GDP were washed away. An economy that was expected to grow at around 7% will now barely attain 1% growth.
Many governments and donor agencies have committed substantial funds for our recovery and reconstruction. We are extremely grateful to all of them. But, out fear is that the promised assistance might take too long to materialise. We are also particularly concerned about the fact that the donor community has been very slow to react in providing assistance for the important task of reconstructing the damaged water and sewerage infrastructure.
Equally urgent is cleaning up debris, garbage and waste piled up in the wake of the tsunami, in order to avert public health risks. However, the huge financing gap in this area, too, has meant that progress in addressing this concern has been slow.
Turning to the various public health problems that the world is facing, I shudder to think of the thousands who die daily in sub-Saharan Africa, all from preventable diseases. In addition, millions of children in polluted cities die each year from acute respiratory infection. Thousands of people all over the world are also dying from HIV/AIDS, drug-resistant strains of tuberculosis, and other communicable diseases. No epidemic has probably ever posed as severe a challenge to humankind as that now posed by HIV/AIDS. More than 20 million people have died from AIDS worldwide. An estimated 40 million are now infected with the virus.
The world today has become very small. Globalization, fast air travel and trade have increased the opportunities for partnerships and socio-economic integration. But these have also opened windows for the rapid spread of infectious diseases from one part of the world to another within a matter of days. While communicable diseases like malaria, TB and cholera continue to be major public health challenges in several countries, concerns about the emergence of new pathogens have become equally worrying.
SARS was the most recent and significant among these new infections. Of no less concern to all of us is avian flu, which is being reported from a number of Asian countries now. This disease has apparently jumped the species barrier and caused several human casualties. It is believed to have the potential of transforming itself into a new pandemic strain, against which the human population would have little or no immunity. According to the scientific community, such a global pandemic could kill over a hundred million people.
While pandemics could threaten to kill millions of people worldwide, there can also be localized health hazards that could have equally, if not more, devastating health impacts on affected communities. A health issue of great concern to the Maldives is that of thalassaemia. Nationally, one in five persons is a thalassaemia carrier and one in every 120 newborns suffers from this genetic disease. The only permanent cure is bone marrow transplantation, which is a treatment not available in the Maldives and prohibitively expensive overseas. If preventive steps to reduce the incidence of thalassaemia in the Maldives are not taken, informed projections show that in 50 years’ time, the cost of treatment could consume over 40 percent of the per capita health expenditure.
International co-operation would be essential in dealing with the vastly changed world public health scenario and the present day global communicable disease profile.
The need to build capacity has been well illustrated by the Global Fund to Fight Aids, Tuberculosis and Malaria, which has made available billions of dollars for health. However, with ill-equipped and understaffed health systems, few developing countries are in a position to make full use of this unprecedented opportunity for health development. I feel WHO can play a crucial role in overcoming this obstacle, and support countries in making use of this opportunity to build their health systems.
There is much that is said these days about global warming, but not nearly enough about the health impacts of climate change. Agenda 21, the blueprint for sustainable development in the 21st century, stressed as its foremost principle, the protection of human health, and emphasized the close nexus between health and the environment.
One might belong to a rural village or a bustling city; live in a slum or in a mansion; work in a farm or in a factory; or dwell in a mud hut on a delta or in a hamlet on the hilltop; but the state of the global environment has a profound effect on each and every person’s health.
According to WHO statistics, over five million children die every year from illnesses and other conditions caused by the environment in which they live, learn and play. Acute respiratory infections aggravated by air pollution, diarrhoea from contaminated food and water, and malaria are the leading causes of death of children in the developing world. I believe all these are preventable deaths, which constitute a great loss to humanity. Madam President:
Climate change is the most pervasive impact of environmental degradation, which is already affecting human health in a variety of ways. Today we know for certain that mankind’s activities are changing the world’s climate.
Under the United Nations Framework Convention on Climate Change of 1992, national governments have a responsibility to carry out formal assessments of the risk to their population’s health posed by global climate change. Let us today reaffirm our commitment to honour this important responsibility.
For a country like the Maldives, the environment poses particular health-related challenges. Our islands are typically small, with porous sand and a thin lens of potable water. The population is dispersed over 200 islands in generally very small communities. The cost of health care is high, with no economies of scale. Even so, considerable progress in the health status of the population has been attained over the past two decades, not only through significant gains in reducing infant, child and maternal mortality and in extending life expectancy, but also in stabilizing population growth.
However, water and sanitation and water management remain problems that require urgent attention. Indeed, in our quest to achieve our stated Millennium Development Goals, the most important challenges are those related to water and sanitation, and nutrition.
Not only does our environment affect morbidity, but it also threatens the very survival of the nation. The most serious form of degradation of the environment is of course global warming, where the rising temperatures could kill the coral which forms the basis of our habitat. We would indeed suffer economic ruin if corals die, but it would also starve the nation of essential supplies of fish which forms part of the staple. Moreover, global warming would also alter the epidemiological pattern, with an increase in vector-borne diseases and the emergence of more virulent forms of tropical diseases. And perhaps what is worse, as the seas rise, the water aquifers and the soil are likely to be poisoned by excess salination.
The Intergovernmental Panel on Climate Change predicts significant rises in global temperatures in the coming years and decades. This would result in sea-level rise and greater frequency and intensity of extreme weather events.
It has been many years since this imminent threat was first diagnosed and the prognosis set out. Coping with diseases and pandemics in a globalised world requires a global and holistic mindset that can generate and sustain the required collaboration worldwide and across various sectors. The links between the environment and health show that addressing the challenges in both areas calls for a global partnership, where everyone becomes part of the solution and none a problem.
Madam President, Distinguished Delegates:
I firmly believe humanity is like the human body; what ails one part of the body affects the whole person. More than others, those who work in the health sector know how it feels to put a smile back on the face of a child, and to bring someone back from the brink of death. But at the end of the day, prevention is still better than cure. And let that be our goal in promoting environmental health.