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Address by Dr Leslie Ramsammy

Minister of Health of Guyana and the President of the Sixty-first World Health Assembly

Sixty-first World Health Assembly
19 May 2008

Vice-Presidents of the 61st World Health Assembly,
Director-General Dr Margaret Chan,
Colleague Ministers of Health,
Excellencies,
Distinguished delegates,
Ladies and gentlemen.

This is not merely a personal honour. I am from Guyana and from the Caribbean Community. I proudly assume the Presidency of this august body, doing so as a representative of the CARICOM region and the countries of American Region (AMRO) of the WHO. I am eternally grateful to all of you for honouring me, my country and the region I represent. Thank you.

I eagerly look forward to lead the 61st World Health Assembly and I sincerely hope we would have a successful 61st World Health Assembly. One thing is certain: there are enormous challenges facing us over the next year and the coming years. Excellencies, I will be sitting here listening to all of you. But first I get this opportunity to speak and for you to listen. Indulge me with your patience just a little. And I caution you, I am a dreamer. This is the 60th anniversary of the WHO. We have much to celebrate. As I speak to you today, I speak not necessarily to our agenda for the next few days. Rather I want to speak about the future work. I speak to this World Health Assembly and future World Health Assembly.

As we meet at this 61st World Health Assembly, too many of our sisters and brothers have lost their lives because of natural disasters and leave their loved ones to cope with great tragedies. In more recent times, the peoples of China and Myanmar (Burma) have had to endure great tragedies. Even as we speak, these countries are coping with the death and disappearance of thousands of their citizens and untold sufferings. Join me, please, to express our heartfelt solidarity with the people, our sisters and brothers, of China and Myanmar, and of other countries that have experienced natural disasters.

There are, still, also, Excellencies and distinguished delegates, far too many of our sisters and brothers suffering from human conflicts. All human conflicts are ultimately public health challenges. These conflicts not only bring great sufferings on millions of people, but diminish humanity, diminish our global aspiration for decent lives for all humanity. "Health for All" is not possible in a world with conflicts. I believe we have the capacity for greater efforts to achieve peace and harmony. We must find the courage to choose peace over conflicts, to choose "Health for All" over political, ethnic, and religious divisions.

I have the audacity to believe that everyone of the 6.7 billion persons living on our earth today can live in peace and harmony. I contend that each of us, of the 6.7 billion citizens on earth, has the same right to live in freedom and in peace.

Excellencies, globally today our peoples are struggling with increasing cost of living, escalating food costs and even shortages of food. The global food crisis constitutes a grave global public health challenge, or rather a public health crisis, coming at a time when the link between good nutrition and health is unequivocal. The WHO has made good nutrition a pillar in promoting healthy lifestyles. The food crisis is now pushing more people into lifestyles of poor nutrition. We are well aware of the reasons for the present global food crisis. The WHO and this 61st World Health Assembly cannot be silent onlookers. The WHO would have lost all moral groundings should it chose to be a bystander in this crisis. This is a public health crisis and I would hope that we find strength and some time to place the global food crisis centre stage on our public health agenda.

I am convinced we must find alternatives for fossil fuels as part of our interventions to slow or reverse global warming. I am convinced the pursuit of biofuel is a reasonable response and can contribute to the reduction of global warming and climate change. But I am equally convinced that conversion of land from food production to biofuel production is a real threat to public health and we need an agreement to ensure conversion of land from food production to biofuel does not precipitate further a food crisis and, thus, a public health crisis. The WHO must take a lead in advocating a prudent way forward. Whenever land for biofuel replaces food production, we must demand vigorous examination to ensure the global food supply is unaffected by such conversions.

Global warming and climate change are too real for many of us, particularly from developing countries, and particularly from small vulnerable states like the Caribbean. We don’t find this fact an inconvenient truth. We are dismayed at the continuing lack of agreement among countries on a way forward. Our collective future is at stake and more needs to be done to stem the tide and prevent greater climate change-related tragedies. Guyana is one country with a net carbon sink and countries like Guyana must be encouraged to preserve such carbon sinks.

Excellencies, distinguished delegates, the chronic noncommunicable diseases (NCDs) increasingly are bringing greater disease burden, accounting for more than half of the global mortalities and global morbidity story. One of my colleagues, Sir George Alleyne, calls it the silent tsunami. I have often referred to it as a festering sore. But indeed, the NCDs have transformed themselves into violent tornadoes bringing death and disability to every country. None of us come from a country that has been spared. The WHO must take its natural place in leading the fight against the NCDs, in ensuring that the NCDs are properly placed as high priority on the global public health agenda.

The WHO has, indeed, played a significant role in highlighting the problem. It is my considered view, however, that we need to catapult our efforts and our advocacy into a more urgent and robust crusade against the NCDs.

In this regard, I want to again highlight the glaring omission of the NCDs in the Millennium Development Goals (MDGs). The MDGs failed to identify the NCDs, in spite of the fact that these diseases account for fully 60% of the global mortalities and in spite of the fact that most of the morbidity and mortality caused by the NCDs are preventable. I believe that this is a serious omission and this anomaly should be corrected. It is in this light that I propose we seriously consider an MDG+, which would set goals for the NCDs, as we have done for other public health challenges.

The 2015 target date for the MDGs are not far away and I am certain pressures would be mounting on countries to achieve the goals established. Unless we include goals for the NCDs now, we are likely to face circumstances which would force neglect of the NCDs as we try to ensure we achieve those goals already identified. My country has decided to proceed with setting an MDG + for the NCDs, as a voluntary addition to the MDGs.

I want to extend my congratulations to the Heads of States in the Caribbean Community who last September held a summit to address the issue of the NCDs, underlining their recognition of the problem and their willingness to collectively tackle the issue of NCDs. These Heads of States clearly recognize that NCD goals are as critical as those in the MDGs. It is for this reason that CARICOM, the countries of the Caribbean, through an edict from the Heads of States, will be observing the first CARICOM Health Day on the second Saturday of September and thereafter every year at the same time. As we address the issues of NCDs, we recognize the importance of lifestyles.

Lifestyle choices have led to a crisis in population health. We must address the crisis of lifestyle. We must address the problem of substance use dependency, including the use of tobacco and alcohol. The global consumption of both alcohol and tobacco constitutes global crisis. We made a start with the Framework Convention on Tobacco Control. We need similar actions with alcohol. Our peoples, while consuming too much alcohol and tobacco, do not consume enough fruits and vegetables. Compounding the problem, our peoples are not engaged in enough physical activity. The consequence is a pandemic of overweight and obesity. These lifestyle choices must be reversed now.

Your Excellencies, our concerns surrounding the increasing numbers of vehicular accidents must be further heightened. We need to pay sustained attention on this growing public health scourge. We have a checkered record on this score. The WHO must be seen as a leading everyday advocate for greater action to prevent disability and death on our roads and highways.

I promised my disabled sisters and brothers in Guyana I would ensure I highlight the public health challenge of disability. The issue of disability has occupied an orphan status for far too long in our public health agenda. We must correct this anomaly. People living with disabilities cannot be ignored any longer and we need to ensure that public health caters equitably for their needs. I want to think that the technology and the tools to prevent blindness and impaired vision are available and we need to ensure these are more widely accessible to avoid preventable blindness. And Excellencies, noise pollution is causing too many of our children and adults to suffer hearing impairment.

“There is no health without mental health" is a global recognition. I believe Mental health is not properly integrated into our primary health care system. What has happened since The world health report 2001?

The world health report 2001 – Mental health: new understanding, new hope brought mental health to centre stage and called upon nations to prioritize mental health as an integral component of health. The world health report 2001 recommended the following actions:

  • to provide treatment in primary care and the community;
  • to make psychotropic drugs available;
  • to educate and involve the public, communities, families and consumers;
  • to establish national policies, programs, and legislation;
  • to develop human resources and link with other sectors;
  • to monitor community mental health; and
  • to support continued relevant research.

Historically due to stigma and discrimination those with mental illness have not received the care they needed to support their recovery to become valuable contributors to civil society. We have the knowledge we need today to provide cost-effective, evidence-informed mental health care to all those who require it without discrimination and to ensure equal access to all health care for those with mental illness. Although we have made significant strides forward we have a long way to go.

Vertical mental health services have perpetuated the segregation and stigmatization of those suffering from mental illness. Mental health can no longer be the orphan of the health care system: it must be integrated into general health services and available in the communities in which people live and receive other services. New models based on population mental health needs can be achieved through enhancing competency of health care providers.

Although I am constraint by time, I would consider it a grave omission and an injustice were I not to address the issues of domestic violence and sexual abuse, particularly of young children. Public health must be visible in taking our place around the table in tackling these major social ills. Substance abuse, colleagues, is a major determinant of domestic violence and sexual abuse, social issues we have been too timid to enter as major players to bring greater attention to, greater action and bring about change. Some persons have questioned our legitimacy in the fight against domestic and sexual violence, putting the responsibility upon social services and security sectors. I posit we have strong legitimacy in demanding a place at the table in tackling these social issues. These are "Health for All" issues.

This is perhaps a good time for me to mention the homelessness situation, but I do not have time to focus on this matter now. Suffice to say, it is a public health problem. I should mention it though, especially since I might very well be one of the homeless myself, for I have no hotel room.

Excellencies, HIV continues to defy our best efforts and our best technologies. Last year a major scientist said we are losing the war against HIV. It’s a cautionary warning. But I am more optimistic and I do not believe losing the battle is inevitable. We must commend those countries that have responded courageously and have made significant dent on the transmission of HIV. Still, I believe that we need a re-energized battle against HIV. I truly believe that we need to make serious adjustments in our responses to HIV. For example, we need to begin earlier treatment for those living with HIV. In this regard, our definition of universal access, taking into consideration restrictions based on CD4 counts, needs re-evaluation. Guyana has moved to earlier treatment of HIV, providing true universal access, an evidence-informed decision. Clearly the benefits of earlier treatment overwhelm the risk of toxicity from treatment. Guyana is also convinced we need to promote more provider-initiated testing and that abstinence-only prevention programmes do not work. Prevention of HIV transmission must be the goal and we must pursue all forms of prevention, including earlier treatment of people living with HIV.

The use of LLINs for the control of malaria has worked and while in itself it is not the total answer, it is an important part of the fight against malaria. There is no excuse for people to be deprived of this simple technology to prevent malaria. We must be heartened by the increasing access to ACT-based treatment for malaria, even though we must accelerate the efforts to bring universal access to ACT-based treatment. Yet we must not ignore the fact that our only alternatives for some forms of malaria are old drugs, drugs in use for more than 50 years and which have shown serious limitations for decades. Research in new medications for malaria is still a major priority and this 61st World Health Assembly must give voice so that a malaria vaccine becomes a major priority in the pipeline of new vaccines.

I believe, too, that unless we ratchet up our fight against TB, it will overwhelm the world. TB is being treated with kid gloves when we need to fight TB with every arsenal we have. We need a war on preventable child deaths. One preventable child death must be considered a calamity. How then do we accept 10 million child deaths per year? The Millennium Declaration has set an ambitious goal for reducing by 75% child deaths by 2015. Excellencies, sometimes we must be bold and I have a dream that one day soon we will, the WHO in front, agree to a global limit for child deaths, regardless of where a child might live. This limit must be our global responsibility, requiring global commitment and resources.

We must have the audacity to demand that the MDGs be the springboard for the global treaty to eliminate all preventable child deaths by 2025. For this to really happen, we must dare to end poverty by 2025. Dreams these are today, but let these be our realities of tomorrow.

With an economy of more than US$ 70 trillion and the global economy doubling at a pace of every 15 years, we have the global resources. Do we have the will? Do we share this moral imperative?

There are new vaccines available that could further reduce child mortality. We must ensure rapid rolling out of these new vaccines. In particular, Guyana appeals for wider and more affordable accessibility to rotavirus, pneumococcus and HPV vaccines. The 61st World Health Assembly must demonstrate our gratitude to the GAVI Alliance that has made it possible for the acceleration of coverage for most vaccines around the world and for the efforts in introducing new vaccines. But I urge GAVI and others to also learn from existing mechanisms. As a representative from the AMRO Region of the WHO, I want to commend the Revolving Fund Program of the Pan American Health Organization as a way forward in collective procurement to reduce transaction costs.

There are many pipeline vaccines. We must work in an energized partnership to realize these new vaccines in time to save more lives and for us to attain our 2015 obligations and for the elimination of preventable child deaths by 2025.

Access, availability and coverage for vaccines in our immunization programmes must not be one of the factors that contribute to the gap between rich and poor countries, between the North and the South and between countries. Vaccines must be seen as a global good. A child born in Africa or Asia or the Caribbean or in South or Central America or in North America or Europe has the same right to a vaccine. There can be no dispute about this. If every child counts, then I cannot fathom a situation where some children are deprived of vaccines, simply because of where they were born.

The WHO must advocate for greater vaccine productivity to meet the world’s demands. Guyana supports the quest for high quality vaccines, but Guyana also is of the view that existing mechanisms are designed to reduce competition and the result is inequity. Developing countries have proven they have the capacity when given a chance to add to the considerable capacity existing in the developed countries. India, Brazil and Cuba and other countries have demonstrated their capacity and we commend GAVI for procuring about 40% of their vaccines from some of these sources. WHO must continue to ensure pre-qualification mechanisms are strengthened to accommodate greater input by fledgling producers.

Coming from Guyana and the Caribbean, from a developing country, I must raise the issue of migration of health care workers from many poor developing countries. Surely, we are capable of some equitable solution to this problem. Yet after many conferences and many agreements, migration of health workers has not abated and has even worsened. Developing countries must benefit from their investment in training, while not limiting freedom of movement. Urgent actions, not more meetings, are needed to mitigate this burdensome problem.

No one can doubt the world has mobilized resources, unprecedented in human history. North America, Europe, the developed countries have responded with solidarity and with generosity to the struggles against diseases. Wealthy individuals and foundations have come forward. These efforts have made the world a better place. These efforts are testimony to what we can accomplish together when we see our problems, rather than when we see the problems as belonging to some of us.

We must at the same time not be timid in realizing that optimal gains are not being realized from these generous flows of resources. Optimal and sustainable use of resources is only possible when disease-specific interventions are integrated in a model of health systems strengthening.

The signs are encouraging in the international mobilization of resources for health. Developed countries have significantly increased their support, as have various other health bodies. But even as we advocate for more resources from these sources of funding, national governments bear special responsibility. Health is about development. There can be no development without health. Health does not come to the table as a mendicant, with its hands outstretched only to receive. Health cannot be regarded as a consumer of resources. Our national productive capacity is totally dependent on health. Thus, national governments must make strenuous efforts to fund health sectors. Guyana has been increasing its allocation to health every year since 1992. But the fact is that many national governments do not spend enough on health. We cannot keep asking others to invest in health on our behalf, without ourselves doing as much as we can. Ultimately national governments must demonstrate their commitment to funding health in their countries, if outside resources will be sustainably utilized.

We have achieved tremendous success in the last 50 years. We must take pride in the fact we have made the health of people better. At the same time we must remember that more than 50 countries now have life expectancies below 50. We must dream and we must realize the vision that no country would have a life expectancy of below 60 by 2025.

Excellencies, Rabindranauth Tagore, the great Indian poet, once wrote that “Fate has allowed humanity such a pitifully meager coverlet, that in pulling it over one part of the world, another has to be left bare”. Tagore even then was saying that we need to share if we are all going to benefit from the coverlet. One of my Presidents, Dr Cheddi Jagan, called it the New Global Human Order. We see it today in the form of PEPFAR, UNITAID, Global Fund, GAVI, Clinton Foundation, Gates Foundation, the new input of resources from developed countries, the US Initiative against Neglected Diseases etc.

These are the stuff of dreams. It shows we can change the world and we can achieve the dream of Alma Ata.

We see the world today with its imperfections and we are tempted to ask why. As we deliberate through this 61st World Health Assembly, I ask we dream of our perfect world and ask why not?

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