Professor Neely,
Dear students and staff of Umeå University,
Good morning, it’s an honour for me to join you this morning to open this year’s Kunskapsveckan, although of course I wish I could be with you in person.
Tack så mycket.
As you know, Umeå University and Sweden hold a special place in my heart, and have played a major role in my career.
And of couse, I was very proud to receive an honorary doctorate from Umeå in 2018.
It was Sweden that financed my PhD, and in 1997 I spent a few months at Umeå that made a huge impact on my studies, and left me with several enduring memories.
The first was that I was in Sweden during summer, and I couldn’t believe that the sun seemed to never go down.
Then they told me in winter it’s the reverse – so I made sure I went home before winter came!
My second memory was that even then Sweden had very high taxes on alcohol, and strict rules on the sale of alcohol.
Twenty-five years later, the public health value of those policies has been clearly proven.
Today, the level of alcohol-related harm in Sweden is lower than many countries in Europe.
And the policies that Sweden put in place decades ago are now WHO’s standard recommendations globally for reducing harmful drinking.
So that's what you call a strategic and long-term intervention, even before the rest of the world was aware of alcohol problems.
My third strong recollection is of the value of what I learned at Umeå.
As part of Sweden’s support for research on agriculture and health, my PhD thesis was on the effect of dams on the spread of malaria in Ethiopia.
Because of the droughts and famine we suffered in the 1980s, the government started a programme to support many villages and towns to build water reservoirs to increase their water security and ultimately food security. But as a result, malaria rates increased dramatically.
My research showed that malaria was seven times more common among children living near the reservoirs than those who lived further away.
At the time I was working very closely with my brother, the late Peter Byass, who was my PhD supervisor at the University of Nottingham and also he was a professor at the university of Umeå.
And it was Peter who suggested that I come to Umeå to do a crash course on some specific epidemiological methods, which became the foundation for my research, and ultimately led to changes that reduced the malaria burden in Ethiopia and saved lives, especially in Tigray region where I did my PhD.
So it’s fair to say that thanks to my time at Umeå in 1997, there are people alive today in Ethiopia who may not have survived otherwise, because the research helped not only in Tigray but in the rest of the country.
Tragically, the area where I did my PhD, Shire, has now been invaded by the Eritrean army, with reports of civilians being looted, massacred and raped, and even villages being burned. You can imagine how painful it could be for me.
This Friday marks two years since the siege of the Tigray region began, with 6 million people cut off from the outside world, with no banking services, no fuel, no telecommunications, and no health care, no food, and media is not allowed, so everything is happening in darkness. And I think Sweden has to do its share in order to prevent genocide in Tigray.
The only solution to this situation is peace, and I hope that Sweden will play its part in the international community to help people who are being massacred, and to bring about peace.
I am so sorry to talk about this, but the memories of Sweden and Umeå which is directly linked to Shire, which is as I said invaded by Eritrean forces and people living there are being massacred.
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The title is "Lessons on the Pandemic," and later on during our discussions, I think Umeå wanted the focus to be on mental health, so although I will say a bit about the lessons, it will be mainly on mental health.
When I started as Director-General more than five years ago, people used to ask me what kept me awake at night. My answer was always, a pandemic.
On the 31st of December 2019 – New Year’s Eve – I received the call alerting me to reports of a new virus spreading in China.
The rest, as you know, is history.
The COVID-19 pandemic has changed our world – and it’s not over yet.
More than 6 million people have died, but the effects of the pandemic have gone far beyond the death and disease caused by the virus itself.
The pandemic has taught us all many painful lessons. The question is, will we learn them?
We are living in a moment that could bring great progress, or great peril.
If we learn the lessons of the pandemic, we could make lasting changes that make the world safer for generations to come.
If we do not, we will perpetuate the cycle of panic and neglect that has characterized the global response to epidemics and pandemics for decades.
There have been several reviews of the global response to the pandemic, with more than 300 recommendations.
Building on these reviews and recommendations, and at the request of our Member States, WHO earlier this year published a White Paper with 10 key proposals for building a stronger architecture for health emergency preparedness and response.
The proposals include actions for stronger governance, stronger financing, stronger systems and tools, and a stronger WHO, under the umbrella of a new pandemic accord.
Most of these proposals are already being acted on.
WHO Member States are now negotiating a new legally binding international accord;
A new fund for Pandemic Prevention, Preparedness and Response has been established at the World Bank;
And in the past year we have launched several new initiatives to enhance global surveillance, local vaccine production, increased sharing of biological samples, and to foster enhanced national preparedness and trust between nations.
One of the principal lessons of the pandemic is that its effects have gone far beyond the death and disease caused by the virus itself.
The pandemic has had profound and long-lasting effects on economies, societies, politics – and it has taken a huge toll on mental health – a toll we are only beginning to understand.
Even before COVID-19, almost one billion people were already living with a mental disorder, including one in ten of the world’s children.
WHO estimates that cases of depression and anxiety have increased by more than 25% since the pandemic began, and that the number of young people experiencing severe emotional symptoms doubled.
The majority of these children do not or cannot access mental health support.
People with severe disorders such as psychosis or bipolar disorder also had a higher risk of hospitalization, severe illness and death if infected with COVID-19.
Promoting and protecting the mental health of young people requires that we create environments where children are safe and have a sense of belonging, and where they can access quality mental health services and support.
Schools have an important role to play on both fronts, given the amount of time children spend at school.
Even in the context of humanitarian emergencies, learning environments are important opportunities to provide safe, nurturing spaces and psychosocial support.
Yet, as we all know, schools and other learning environments are not always safe places. They can be sources of emotional distress and discrimination, and sometimes even of violence.
Much work needs to be done to improve mental health services in schools, which may be under-resourced and use a patchy approach not always informed by evidence.
To address this situation, WHO and UNICEF have produced the Helping Adolescents Thrive toolkit, which includes guidance on mainstreaming mental health promotion and protection in schools, supported by case studies.
We have also initiated a joint programme on the mental health and psychosocial well-being and development of children and adolescents.
The health and wellbeing of children around the world depends on safe and nurturing educational environments, and high-quality, evidence-based mental health services for those who need them.
Making this a reality, in even the most difficult and under-resourced environments, requires sustained financial commitment and coordination across the education and health sectors, with support from multilateral organizations.
Teachers, administrators, and educational leaders – and young people themselves – must all be engaged, to build new competencies, implement critical changes to systems, and maintain accountability.
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COVID-19 has highlighted the gaps in the capacity of health systems around the world to address mental health conditions.
Unfortunately, the increase in the prevalence of mental health problems coincided with disruptions to mental health services.
Nearly half of countries surveyed by WHO reported disruptions to services for mental and neurological health and substance use.
Again, services for the most vulnerable groups, such as older adults and children, were among the most affected by disruptions.
Globally, investment in mental health remains low, and the stigma surrounding it remains high.
At times of crisis, when we need more and better-quality mental health services, the world is held back by decades of under- investment.
Even before the pandemic, mental health services were far too limited in most countries.
COVID-19 has triggered an unprecedented mental health crisis, but it is has also brought mental health to the forefront. As such, it’s an unprecedented opportunity to make significant changes to protect and promote mental health around the world, especially for young people.
WHO’s World Mental Health Report, published in June, calls for three fundamental transformations:
First, to transform the way we see mental health.
This means valuing mental health as a key component of health and well-being, stepping up investments in services for mental health, putting in place evidence-based policies, and including people with mental health conditions in all aspects of society to reduce stigma and discrimination.
Second, to transform the environments that influence mental health.
This means action to address risk factors for mental health, including violence, abuse and neglect; improving early childhood development; and banning pesticides that are associated with one fifth of all suicides globally.
And third, to transform services for mental health.
This means building community-based networks of services that move away from custodial care in psychiatric hospitals, and integrating mental health services in primary health care - mainstreaming it.
It also means addressing the mental health component of other diseases and conditions, and ensuring that mental health is integrated into policies for education, labour, justice and housing.
Crucially, it’s essential that services for mental health are integrated into primary health care, as part of every country’s journey towards universal health coverage. In Sweden, that's not a problem, universal health coverage.
Equally, it’s vital that services for mental health are covered by health insurance and entitlement schemes, so that no one is exposed to financial hardship – and the stress and anxiety that goes with it – as a result of paying for mental health care out of their own pockets.
Every country, no matter its situation or income level, can significantly improve the mental health of its adults and children.
The links between mental health and public health, human rights and socioeconomic development mean that transforming policy and practice in mental health can deliver real, substantive benefits for individuals, communities, economies and countries everywhere
As educators, you can play a vital role in each of these transformations:
By teaching your students about mental health;
By creating environments where it’s okay not to be okay;
And by advocating for improved mental health services in schools and universities.
Because ultimately, there is no health without mental health.
Thank you once again for this opportunity, and I look forward to our discussion for the remainder of the hour.
Tack så mycket.