Dr. Brundtland speaks to World Health Assembly

[Robert Weissman <rob@essential.org>]

Dr. Gro Harlem Brundtland of Norway will soon be taking over the top
position at the World Health Organization. This holds enormous promise for
making the WHO a much more powerful and effective organization. In this
speech to the World Health Assembly, the governing body of WHO, Brundtland
specifies that tobacco will be one of her top priorities at WHO.

Robert Weissman
Essential Information			|   Internet:	rob@essential.org


Dr. Gro Harlem Brundtland
Director General Elect, The World Health Organization

Speech to the 51st World Health Assembly
Geneva, 13 May 1998                                       
        
Mr President,

This is a special moment of responsibility. You have
given me confidence and I feel responsible towards all of
you and to the peoples that you represent.

Since I made my basic choices in life I have thought of
myself a doctor who wanted to heal and who wanted to
change. Not least to change the causes of suffering and
injustice.

I believed that societies can be changed and that poverty
can be fought. That people working together can achieve
impressive results. This I still think and know. We can
harness the resources. We can mobilize the will. We can
inspire the extra effort. 

I feel that I can ask for, and that the peoples of the
United Nations have the right to count on your support
and active participation in the future work of the World
Health Organization. That support will be needed. There
is hard work ahead.

I may ask for more than you have been used to being
asked. You represent the owners of WHO, the shareholders
and the stakeholders, all those who need us to succeed.

We need political guidelines from this Assembly. We
depend on how members states follow up at home. We depend
on how they live up to the imperative of equity and
social justice, expressed in health for all.

The challenge goes to all of us. WHO can and must change.
It must become more effective, more accountable, more
transparent and more receptive to a changing world. 

Member states must take responsibility for the targets
they set and provide resources. They must practice what
they preach from this rostrum.

I believe we can forge stronger relations with member
states. Keeping you better informed of how WHO develops,
seeking your advice and when needed asking you for an
extra contribution. 

Without a sense of partnership between the organization
and its owners, our work will prove exceedingly
difficult. With a unity of purpose we can unleash real
momentum for health.

That momentum will be needed as we approach a new century
where WHO must cope with complex processes of transition.

The transition from one century to another sees changes
which will be faster and more dramatic from an economic,
social and health perspective. 

The 20th century gave the world more health advances than
in the entire previous history of mankind. Still we are
faced with daunting challenges. Above all they are linked
to the persistence of poverty. The imbalances are
striking. People in developing countries carry over 90
per cent of the disease burden, yet have access to only
10 per cent of the resources used for health. This is
unacceptable. This has to change. 

Wealthier countries will benefit by contributing and they
have the moral obligation. Governments in poorer
countries must acknowledge their responsibility, they
have a moral obligation to give priority to health and to
equitable distribution of health services.

We have another transition, the transition from the
communicable to the non-communicable diseases. They can
not be seen as competing tasks. They are complementary.
We need to fight both. The burden of disease is the
burden of unfulfilled human development. 

I hear some say that infectious disease is becoming
yesterday's problem. But is that correct? I don't believe
so. There is an unfinished agenda of eradication and
rolling back diseases. No one should underestimate
childhood infections, HIV/AIDS, TB, malaria, polio and
the other new and emerging diseases. They may hit us all
in this small world - but above all they keep ravaging
the lives of the poor.

WHO must be an enduring advocate in the fight against
infectious diseases. And WHO must help governments face
the daunting challenge from the new epidemic of
non-communicable diseases, now spreading in the low- and
middle-income countries. 

We need to anchor health in a broad setting.
Globalization is opening up new opportunities for growth
and progress. But the benefits are not adequately
distributed. Globalization has also brought new and
critical threats to health and the environment. 

We have to reach out to new arenas critical for the
health of billions. The next century may well be one of
great environmental crises. But it need not be. We still
have the opportunity to make timely decisions before we
have to pay the bills of overburdening the capacity of
the planet, its resources and most importantly - the
health of its people.

World trade, environmental changes, lifestyles and
culture; in all these fields we must be able to analyze
the driving forces and speak out for health and
development.

The world is in transition. So accordingly WHO must be in
transition. Looking ahead.

Our constitution provides us with a broad and impressive
mandate. But a mandate is no roadmap. It must be made
according to the needs - of the people, the communities
and the nations we are meant to serve. We need to focus
our work.

Poverty is the greatest threat to people's health.
Ill-health leads to poverty - and poverty breeds
ill-health. Governments must take it seriously. Childhood
diseases, malnutrition, spreading infections and excess
fertility, we know the results. 

Only a broad alliance can manage this critical task. WHO
must be the health component of that alliance - impatient
and ready to lead when required, our special contribution
being to fight ill-health.

In this process of transition - what is our key mission?
I see our role as being the moral voice and the technical
leader in improving the health of the people of the
world. Ready and able to give advice - not on every issue
- but on the key issues that can unleash development and
alleviate suffering. I see our purpose to be combating
disease and ill-health - promoting sustainable and
equitable health systems in all countries.

What should be our motivation? My answer is short: Making
a difference. We should measure our work in full
transparency - sharing and learning from successes and
failures - our own and those of others.

There are two roads we must follow: 

One road leads to our work on the ground. We must combat
disease, premature death and disability. We must give
advice on best practices to achieve equity and quality,
set standards and norms. We must encourage, support and
trigger the best research and development.   

The other road leads to the levels of political decision
making where the broader agenda for development is set.
We must speak out for health in development,  bringing
health to the core of the development agenda. That is
where it belongs, as the key to poverty reduction and
development underpinned by the values of equity, human
dignity and human rights.

This is why I wish to focus the technical support and
normative work of the World Health Organization and at
the same time bring the organization more firmly into the
political arena. 

I wish to organize our programmes and activities around
key functions that tell a clear story of what business we
are in. I wish to concentrate our resources in a way
which enables us to do fully what we decide to do - and
to let go what we decide not to do - either because
others do it better or because we simply can't do all.

In the reorganization - which I intend to start
implementing from the very first day - I will focus on
four areas of concern: 

* WHO will help monitor, roll back and where possible
eradicate communicable diseases.

* WHO will help fight and reduce the burden of
non-communicable diseases.

* WHO will help countries build sustainable health
systems that can help reach equity targets and render
quality services to all, with a particular emphasis on
the situation of women and mothers who are so critical
for giving children a safe and healthy start in life. 

* WHO will speak out for health, back its case with solid
evidence and thereby be a better advocate for health
towards a broader audience of decision makers.

To succeed in this endeavor we must be able to say: WHO
is one.    
Not two - meaning one financed by the regular budget and
one financed by extrabudgetary funds. Not seven - meaning
Geneva and the six regional offices. Not more than fifty
- meaning the individual programmes.

WHO must be one: Setting its priorities as one, raising
additional financial resources as one, speaking out as
one. And then - but only then - can we act effectively in
our decentralized diversity through skilled presence at
the country level, through regional guidance by the
regional offices and through global direction by the
headquarters and the governing bodies.

With this structure and spirit in place I am ready to
give a short answer when asked about my priorities: The
World Health Organization is my priority. 

A WHO that can engage where the needs are greatest. A WHO
that is trusted to maximize its resources. A WHO with
excellence. A WHO that can truly make a difference.

With this structure and spirit in place WHO will be the
lead agency in world health. But we need a change in
attitude. We cannot point to our Constitution and say: We
have the right to be the lead agency. We must earn our
leadership. We must demonstrate through the way we plan,
structure and carry out our work that we make a
difference that we and others can measure.

To succeed there are a few basic requirements:

First , we need a stronger partnership with the member
states. 

Countries must report back to us on their health status.
We need to improve our work at the country level,
especially in developing countries - in cooperation with
national authorities but also by drawing on and expanding
the contact with collaborating centers. Technical
cooperation must be relevant and address the needs. 

We will need a much stronger focus on how health sectors
are tailored to sustain activities that secure the
quality and distribution of services. I will propose that
health sector development becomes an integral part of all
our activities. Each of our disease control units will
have to identify sectoral issues where they can
contribute and capacities that must be strengthened for
them to do their jobs. We should not engage unless our
work can make a direct contribution to the overriding
purpose of building and strengthening the health sector.

Second, we must reach out to others. 

The global health field has seen a steady increase in the
number of actors and stakeholders. This we should not
fear. I wish to invite those who have real contributions
to make to join us.

The other UN agencies are our closest partners. I pledge
a strong support to the Secretary General's call for more
inter-agency cooperation. 

One obvious area is to lend full support to UNAIDS
together with the other patrons of that programme. The
regions most ravaged with AIDS are coming close to what
most of Europe faced during the plagues of the 14th
century. 

We must make an extra effort in the crucial combat
against the HIV/AIDS pandemic, especially in the most
vulnerable countries. We must help the health systems to
cope. We must help make the scientific advances available
also to the developing world.

We must reach out to the international financial
institutions, the World Bank, IMF and the regional
development banks. They have a major role to play in
financing sustainable development.

They too are involved in health. They carry a major
responsibility. We should welcome this, while reminding
them of the need to safeguard health and social services.
Our voice is needed to remind both governments and
financial institutions that budget cuts should not be in
critical sectors such as health and that the long term
expenses of disengaging in public health will go beyond
the short term budgetary gains.

We must reach out to the NGO community. 

Their reach often goes beyond that of any official body.
Where would the battle against leprosy, TB or blindness
have been without the NGOs? I will convene a conference
with the NGO community to draw up new guidelines for our
cooperation to establish new mechanisms for interaction
with civil society in member states.

We must reach out to the private sector. 

Countries need a well performing public sector.
Governments should ensure universal coverage of health
services. We have seen evidence that growing reliance on
private financing mechanisms, including private voluntary
insurance, risks massive cost escalation. A key role for
public finance of universal coverage results in greater
equity but, also, in reduced waste and inefficiency.

The private sector has an important role to play both in
technology development and the provision of services. We
need open and constructive relations with the private
sector and industry, knowing where our roles differ and
where they may complement each other. I invite industry
to join in a dialogue on the key issues facing us. To
this end I will propose the creation of a WHO-industry
roundtable and convene a first meeting before the end of
the year. 

Third, we must underpin our work with solid facts. 

For WHO to be the leading advocate for health we need to
know the relevant facts, not only have the conviction
that health is essential. Health is not only a moral
obligation and a basic human right. Health is pure and
sound economics.

In July I will establish a separate function on Evidence
for Health Policy. We need to get our statistics right
and keep them right through research and constant update.
Reaching goals based on values are also measurable.. We
need to know the burden of disease and how health policy
can contribute to change. We need to know the
cost-effectiveness of intervention and we need to define
our priorities accordingly.

To be the leading advocate for health we need to take
that evidence to decision makers around the world. We
will report on the news of fact. And the fact is that
healthy people help build healthy economies. 

You - the Health Ministers - need no further convincing.
But WHO - with you - should remind Presidents, Prime
Ministers and Finance Ministers that they are truly
health ministers themselves, key to the well being of
their people. Health investments are sound investments
for poverty reduction and economic growth. 

Mr. President,

When I take office on 21 July my first task will be to
respond to your call for reform here in Geneva and in the
interaction with regions and countries. 

I said that WHO is my priority. Don't expect to see me
constantly traveling to the four corners of the world in
this first phase. I look forward to attending the
meetings of the Regional Committees in September. Beyond
that I will devote my attention to the running of the
organization. 

A first task will be to suggest certain amendments to the
current budget built on the directions that I have
already indicated. A next task will be to take these
directions into the preparation of the 2000-2001 budget
and to present my orientation for our next program of
work. 

I know that the timing is critical. But it can be done so
that the Regional Committees can provide input in time
for their September meetings. 

I strongly believe that WHO can say more with fewer
volumes of documents, fewer reiterations of what we all
agree and more focus on what we are here to do. I also
believe we can do with a flatter structure and fewer
layers. Information and communication must flow.

I will gather the new senior management team around my
table on a weekly basis - addressing an agenda which is
well prepared - taking shared responsibility for projects
and initiatives.

I wish to meet more frequently with the Regional
Directors, inviting them to take part in the management
of the whole organization. We will take advantage of new
technologies which will allow us to meet on the
information highway securing the unity of purpose that
this organization needs.   I wish to establish more
direct links to the country representatives seeing to it
that they have a clear understanding of our priorities
and their evidence base, and that we get their feed back.
Through much closer interaction I wish to see a more
concerted elaboration of our programmes and projects in
countries that need them.

I wish to see WHO attract the best expertise there is -
inviting people to come - not all to spend a life long
career with us - but to share their knowledge and
expertise and then move on with what they have learned.
Sharing knowledge means a greater degree of mobility
among staff - between the three levels of our
organization - and also between WHO and other agencies. 

Staff is WHOs prime resource. We should do more to offer
staff opportunities to develop and refine their knowledge
and expertise. In July I will propose a staff development
package including training opportunities - not for the
fortunate few - but for the many. And I will invite the
Staff Associations into a structured dialogue on working
conditions and arrangements.

I wish to increase the number of women in the
organization. There is a long way to go to reach the
targets set by the World Health Assembly and the
Executive Board. But I will take targets seriously and I
intend to make sure that we reach them. 

So here is the message to all women who have first class
expertise to contribute, especially women from the
developing world: This is important work. Get in touch
and let us know.

I wish to strengthen our programmes. Not as independent
units separated from each other. Not as separate fund
raising bodies sending different signals about our
priorities,  but as centers of excellence. Some times
co-sponsored by others, but always open to the rest of
the organization and to each other. Not overwhelmed by
administrative functions, but encouraged and supported to
bring our shared knowledge further.

I believe there is a lot to gain from organizing part of
our activities into projects. Not too many, but easy to
define, easy to identify, open for our partners to
co-sponsor - and transparent for donors to lend their
financial support to.

Let me mention two such projects which I wish to start
implementing from 21 July.

I propose that together we Roll Back Malaria. Not as a
revamped vertical program but by developing a new health
sector wide approach to combat the disease at global,
regional and country and local levels.  

Why malaria?  Many have asked this question.  For my part
the answer is simple, I have learned it from many in this
room and by traveling to your countries, particularly in
Africa.  

Malaria is the single largest disease in Africa and a
primary cause of poverty. Every day 3000 children die
from malaria. Every year there are 500 million cases
among children and adults. 

Who said that infectious diseases were becoming
yesterday's problem? The human suffering is unacceptable
and so is the economic burden and impediment to progress. 
Time has come to respond with a new approach. Time has
come to Roll Back Malaria.

Why now? Because the call is there. We have enough
knowledge, skills and tools to launch a new concerted
effort. Africa is responding. African leaders are
committing to a renewed effort to control malaria. Africa
should be spearheading the project. 

I believe we should answer Africa's call and that of
other regions if they choose to engage. I will invite a
broad range of stakeholders to join us in this
initiative, UNICEF, the World Bank, industry, foundations
and all others who have a stake, a commitment and a
contribution to make. 

I encourage the leaders of the G8 countries to answer the
call when they meet later this week.

Let me stress: Roll Back Malaria will not exclude work on
other diseases. To the contrary. Successful containment
is no endpoint. Rolling Back Malaria is no victory unless
health systems are equipped to sustain the gains. 

That means connecting the services with the primary
location for action; the family - the home - and the
mother.  Efforts against all infectious diseases will
benefit. Drawing upon what we learn we will be ready for
a fast track on a future Roll Back TB - and a
reinvigorated action against HIV/AIDS and the tropical
diseases.

My second emphasis is in the field on non-communicable
diseases. We need to address a major cause of premature
death which is dramatically increasing - killing 4
million people this year - and - if we let it go on
without action - 10 million people in 2030 - half of them
dying in middle age - not old age. The major focus of the
epidemic is now shifting to the developing countries. 

I refer to tobacco. I am a doctor. I believe in science
and evidence. Let me state here today. Tobacco is a
killer. 

We need a broad alliance against tobacco, calling on a
wide range of partners to halt the relentless increase in
global tobacco consumption.

Children are the most vulnerable. Habits start in youth.
The tobacco industry knows it and acts accordingly. This
is a medical challenge, but also a cultural challenge.
Tobacco shouldn't be advertised, subsidized or glamorized.

Mr. President, 

I wish to get to work on 21 July on a challenging agenda,
demonstrating that we can make a real difference. There
are important achievements to build on: 

Child mortality is decreasing. We must push the numbers
further down. 

Immunization rates have taken a dip. We must push the
numbers further up.

Mental health is slowly gaining acceptance as a major
public health concern. We must push for the evidence and
the best policy advice.

Women are the prime caretakers. We must push for real
change for women, children and families.

The Cairo Summit put population and reproductive health
on the agenda but there is still so much to do. We must
help doing it. 

My motivation will be this: Making a difference. I see
that as a privilege - being able to make an effort -
being one of many dedicated people working together for
what we believe in.

I  envisage a world where solidarity binds the fortunate
with those less favored. Where our collective efforts
will help roll back all the diseases of the poor. Where
our collective efforts assure universal access to
compassionate and competent health care.

Bringing the world one step closer to that goal is our
call for action.