Global health improvement and WHO: shaping the future
A world torn by gross health inequalities is in serious trouble. The global health community can do much to reduce suffering and death among vulnerable groups. WHO is changing its way of working, alongside member states and financial and technical partners, to reach key national health goals and strengthen equity. The most urgent objectives include the health-related Millennium Development Goals, the 3 by 5 target in HIV/AIDS treatment (to provide 3 million people in developing regions with access to antiretroviral treatment by the end of 2005), and addressing the growing epidemics of non-communicable diseases. The key to achieving these objectives is strengthening of health systems guided by the values of Health For All.
Introduction
Inequalities scar the world's health landscape. The newly released World health report 2003-shaping the future reveals that a baby born today in Afghanistan is 75 times more likely to die before age 5 years than a child born in Iceland or Singapore. Life expectancy at birth in Sierra Leone is less than half that in Japan.1 The antiretroviral drugs routinely prescribed to people with HIV/AIDS in wealthy countries have greatly extended and improved life for many. But of the estimated 4.1 million people in sub- Saharan Africa in urgent need of such drugs, fewer than 2% have access to them.
A world torn by such inequalities is in serious trouble. By acting resolutely to correct these injustices we can do much to improve the collective future of humankind. Many of the determinants of unequal health outcomes- such as poverty, armed conflict, and levels of education in women-lie outside the control of the health sector. Yet the worldwide health community can do much to reduce suffering and death among vulnerable groups, if we are prepared to go beyond a "business as usual" approach. WHO is changing its way of working, alongside member states and financial and technical partners, to reach key national health goals and strengthen equity. The most urgent objectives include the health-related Millennium Development Goals and the 3 by 5 target in HIV/AIDS treatment: to provide 3 million people in developing regions with access to antiretroviral therapy by the end of 2005.
Are WHO and its partners up to these challenges? The answer is: we have to be. Two decades of experience in WHO give me a clear sense of the organisation's strengths and limitations. To meet urgent goals, we are making changes. But we will build on the past, reinforcing strategies that have brought results, expanding channels of communication and feedback to quickly measure the effects of innovation.
I began my WHO career working on leprosy control in Fiji. My years at country level and in WHO's western Pacific regional office in Manila shaped my vision of public health work and of WHO's role. Global normsetting, research, and determined health advocacy within international forums are crucial. But the real test comes in countries-through technical cooperation and policy work with national authorities and communities. Health improvement in countries will be the criterion of WHO's success in the years ahead. Working to rapidly strengthen health-care systems is the key to meeting health goals and reducing inequalities in access and outcomes.
This article is not an exhaustive account of WHO's priorities. The focus is on themes that, in addition to their own intrinsic importance, illustrate broader changes in WHO's way of working. The article will: identify bedrock ethical values for international public health; describe some of today's main health challenges; and indicate specific actions WHO will undertake, in collaboration with partners, to address these challenges. The key message is that urgent action to meet targets such as 3 by 5 and the Millennium Development Goals must drive a horizontal strengthening of health-care systems. Sustained progress toward these targets will be impossible in many areas without a systematic reinforcement of basic health-care infrastructure. Scale-up of health systems should be guided by the principles and practices of primary health care, adapted to a rapidly-changing health landscape.