[Ip-health] #wha67: Dr. Margaret Chan-Health has an obligatory place on any post-2015 agenda

Thiru Balasubramaniam thiru at keionline.org
Mon May 19 23:07:08 PDT 2014


Health has an obligatory place on any post-2015 agendaDr Margaret Chan
Director-General of the World Health Organization

Address to the Sixty-seventh World Health Assembly
Geneva, Switzerland
19 May 2014

Mister President, Excellencies, honourable ministers, distinguished
delegates, ambassadors, ladies and gentlemen,

On 5th May, I declared the international spread of wild poliovirus since
the start of this year a public health emergency of international concern.
I did so on the advice of an emergency committee convened under the
International Health Regulations.

That declaration included recommendations for vaccination certification of
travellers from three countries known to be seeding outbreaks elsewhere. No
travel restrictions were imposed.


In just the past few months, social inequalities, within and between
countries, have attracted the attention and deep concern of leading
economists and development banks. They have issued a spate of warnings
about the disruptive effects of rising inequality and economic exclusion on
social cohesion and stability, about the damage done to economies and the
risks to future prosperity.

Wealth does not trickle down. Some economists argue that the past practice
of equating growth in GDP with overall progress is outmoded. These views
carry weight and should be taken seriously.

Signals about what human activities have done to the environment are
becoming increasingly shrill. Our planet is losing its capacity to sustain
human life in good health.


Estimates for 2010 indicate that cancer cost the world economy nearly $1.2
trillion. No country anywhere, no matter how rich, can treat its way out of
the cancer crisis. A much greater commitment to prevention is needed.

The same is true for heart disease, diabetes, and chronic lung diseases. In
some middle-income countries, diabetes treatment alone is now absorbing
nearly half of the entire health budget.

Not only has the disease burden shifted since the start of this century.
The poverty map has changed.

Today, around 70% of the world’s poor live in middle-income countries. As
more and more countries graduate to middle-income status, they also
graduate from eligibility for support from the Global Fund and GAVI, and
for concessional prices for medicines.

We need to ask some questions.

Will economic growth be accompanied by a proportionate increase in domestic
budgets for health? Will countries put polices in place to ensure that
benefits are fairly shared? If not, the world will see a growing number of
rich countries full of poor people.

International trade has many consequences for health, both positive and
negative. One particularly disturbing trend is the use of foreign
investment agreements to handcuff governments and restrict their policy

For example, tobacco companies are suing governments for compensation for
lost profits following the introduction, for valid health reasons, of
innovative cigarette packaging.

In my view, something is fundamentally wrong in this world when a
corporation can challenge government policies introduced to protect the
public from a product that kills.

Some Member States have expressed concern that trade agreements currently
under negotiation could significantly reduce access to affordable generic

If these agreements open trade yet close access to affordable medicines, we
have to ask: Is this really progress at all, especially with the costs of
care soaring everywhere?

We learned that markets cannot sell something to people who cannot pay.
Childhood immunization programmes deliver vaccines at no cost to
recipients. The massive free distribution of bednets coincided with
dramatic drops in malaria cases and deaths.

The bottom billion receive medicines for neglected tropical diseases at no
cost. Universal health coverage goes hand-in-hand with financial risk
protection, especially for the poor.

But we also learned that policies matter as much as money. Countries with
the same level of resources achieve strikingly different health outcomes.
The right policies, especially when they make equity an explicit objective,
make the difference. This underscores the decisive role of domestic
leadership, and is one reason why appreciation for country ownership has

We learned, too, how much the world needs an organization like WHO. Within
the framework of our leadership priorities, WHO is shaping the health
agenda as needs evolve, and using multiple mechanisms and partnerships to
meet these needs. If anything, the relevance of this Organization has

WHO leads in line with need. The leadership role given to WHO by the 2011
UN political declaration on NCDs came with a number of time-bound
responsibilities, which we continue to fulfil.

Much of our work has direct relevance in countries. We identified “best
buys” for NCD prevention and control. We used our authority to alert the
world to the need to reduce daily sugar consumption, based on evidence of
the association with dental caries and obesity.

We continue to support the health needs of the elderly: their need to stay
in their homes as long as possible, their need for people-centred care that
looks after co-morbidities, including mental problems like dementia.

WHO shapes policies. The growing commitment to universal health coverage
can act as a counterweight to many of the trends I have described. UHC is
one of the most powerful social equalizers among all policy options.

The World Bank is now a welcome partner in helping countries make their
health systems more inclusive. This engagement sends a strong signal that
UHC is financially feasible and makes good economic sense.

WHO gets the prices of commodities down, helping countries and donors get
more from their investments. The prequalification programme makes supplies
of medical products more plentiful, predictable, and affordable. Pooled
procurement gains economies of scale.

WHO facilitates negotiations with industry for concessional prices. For
drugs for diseases of the poor, WHO negotiations have cut prices by as much
as 90%. For the neglected tropical diseases, WHO negotiates and manages
very large drug donations from multiple industry partners, amounting to 900
million doses last year. This is a huge undertaking with huge benefits.

WHO constantly monitors evolving trends and sounds the alarm when needed.
For communicable diseases, one of the most alarming crises is the rise of
antimicrobial resistance, which WHO documented in a report last month. This
is a crisis that now affects every region of the world, and it is only
getting worse. The new report on adolescent health is another alert to
neglected needs.

WHO takes up the cause for orphan problems, and gives them a home. When I
took office, I was told that strengthening health systems has zero appeal,
zero glamour for donors, and low priority on the development agenda. This
has thankfully changed.

We are now arguing for similar attention to regulatory capacity. Countries
must have well-functioning regulatory authorities to protect their
populations, whether from tainted food, unsafe medical products, tobacco,
drink-driving, air pollution, notifiable infectious diseases, or the
marketing of unhealthy foods and beverages to children.

Ladies and gentlemen,

For health, the previous century largely relied on the technology-driven
medical model to combat communicable diseases. With NCDs now the biggest
killers worldwide, this century must be an era where prevention receives at
least as much priority as cure.

Last year, I attended an international conference that looked at strategies
for a tobacco end-game, that is, strategies that could end tobacco use

Thirty years ago, who could have imagined that health could take such a
firm stand against such an economically and politically powerful industry?

Given the importance of prevention to protect healthy human capital, we
will need to argue for the supremacy of health concerns over economic
interests with other industries. This will not be easy.

As recent experience shows, even the very best scientific evidence can have
less persuasive power than corporate lobbies.

For the post-2015 agenda, I see many signs of a desire to aim ever higher,
with ambitious yet feasible goals. Many more end-games are already on the
table. End preventable maternal, neonatal, and childhood deaths. Eliminate
a large number of the neglected tropical diseases. End the TB epidemic.

We have at our disposal a host of strategies for pursuing ever higher
goals. Some of these strategies have been refined by two large programmes
that are marking their 40th anniversaries this year: the Expanded Programme
on Immunization, or EPI, and the Special Programme for Research and
Training in Tropical Diseases, or TDR.

The establishment of GAVI in 2000 helped launch the most innovative EPI
decade to date. Tomorrow, GAVI is meeting development ministries of the
European Union to launch a drive to extend access to vaccines even further.
I join fellow GAVI partners in offering my full support to this launch and
a successful GAVI replenishment.

In recent years, TDR has moved away from its initial focus on product
discovery and development to concentrate more on implementation research
for communicable diseases of the poor. TDR now uses the tools of scientific
investigation to understand why good drugs, good diagnostic tests, and good
preventive strategies fail to reach people in need. In other words, to find
the barriers to access and break them down.

TDR also innovates to help countries get the most out of their resources.
One example stands out. The original strategy of community-directed
treatment to deliver ivermectin for river blindness was expanded to support
integrated delivery of a range of critical health interventions.

Ladies and gentlemen,

As I conclude, let me thank Member States, the owners and shareholders of
this Organization, and their Geneva missions, for taking us so far on the
road to WHO reform. The two financing dialogues held to date proposed
solutions to problems that have hindered our performance for years.

Given the challenges that lie ahead, and the high expectations for health,
WHO’s dedicated and committed staff will need to perform better than ever.
We are well-motivated to do so.

Better health is a good way to track the world’s true progress in poverty
elimination, inclusive growth, and equity.

Thank you.

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