[Ip-health] Dr. Margaret Chan's ((Director-General Elect)) speech to the World Health Assembly

[Thiru Balasubramaniam]

<SNIP>

As I said yesterday, this is also a moment of reflection and respect.
We are all here because of the untimely death of Dr LEE Jong-wook. We
are also all here because of many millions of untimely deaths. I know
Dr Lee would have wanted me to make this point. He will always be
remembered for his 3X5 initiative. That was all about preventing
untimely deaths on the grandest scale possible.

<SNIP>

And I would like to recognize in the audience our Emeritus
Director-General, Dr Mahler.

I am firmly committed to taking this legacy forward.

<SNIP>

  Here is another thing we must do. We must act when the problem is
great but we don=92t yet have the tools. In 1950, the top three
priorities at WHO were sexually transmitted diseases, malaria, and TB.
Substitute HIV/AIDS for sexually transmitted diseases, and things have
changed very little.

WHO must influence the research and development agenda. For these and
other diseases, we will not be able to make major strides forward until
we have new vaccines, new drugs and new diagnostic tools. In addition,
we must find the right balance between the protection of intellectual
property rights and access to affordable essential medicines. This is
not easy! But we cannot be evasive.



---------------------------------

http://www.who.int/dg/chan/speeches/2006/wha/en/print.html

World Health Assembly
9 November 2006

Speech to the World Health Assembly
Dr Margaret Chan, Director-General Elect


This is a moment of great personal honour for me, but also one of deep
responsibility. I do not take this responsibility lightly. I have
always been proud to work in health, and especially proud to work for
WHO. Now I will take pride in a position of leadership that has a
direct impact on the health of humanity.

That is the power of this Organization, it=92s true greatness. The work
we do together saves lives and relieves suffering. I will work with you
tirelessly to make this world a healthier place.

As I said yesterday, this is also a moment of reflection and respect.
We are all here because of the untimely death of Dr LEE Jong-wook. We
are also all here because of many millions of untimely deaths. I know
Dr Lee would have wanted me to make this point. He will always be
remembered for his 3X5 initiative. That was all about preventing
untimely deaths on the grandest scale possible.

I am proud to work for WHO because it is an organization that is
increasingly recognized for what it does, as well as what is says.

This is an organization that measures its achievements in terms of good
work, good results =96 and not numbers of reports or meetings. An
organization that is opening itself up to the scrutiny of member states
as never before. An organization that is committed to technical
excellence. This legacy was created by the work of Dr Lee and his
predecessors.

And I would like to recognize in the audience our Emeritus
Director-General, Dr Mahler.

I am firmly committed to taking this legacy forward.

Mr President,

Members of the Executive Board have heard my vision for WHO. Others
have not.

In the next few minutes, I want to communicate this vision of what I
believe we need to do, our greatest strengths in undertaking these
activities, and our greatest challenges. The challenges are especially
important. It is in these areas where the adequacy of our performance
must be measured.

I have great optimism for the future. But I have worked in public
health for 30 years. I have no illusions. Our success in giving health
a central place on the development agenda has opened new opportunities,
but has also made our work more complex. We have made great strides in
some areas, but seem to be standing still in others.

As a world, we face global as well as local threats to health.
Infectious diseases have staged a dramatic comeback. HIV, Ebola, SARS,
and avian influenza will not be the last bad surprises delivered by the
ever-changing microbial world.

In leading WHO, I will =96 like all my predecessors =96 need to manage
three main sets of issues: technical, administrative, and political. In
doing so I will leave my personal stamp. It is this: I am determined to
attain results for health.

I am sure we have the power to do so. But we need to be smart in our
planning and priority setting, and street-wise in our actions. Health
is not an abstract issue at global and national levels, but a concrete
reality that touches individuals, households and communities.

So let me be clear about the results that matter most. Reducing the
burden of disease is important. Improving the strength of health
systems is important. Reducing the threat of risk factors for disease
is important.

These are all vital. But what matters most to me is people. And two
specific groups of people in particular. I want us to be judged by the
impact we have on the health of the people of Africa, and the health of
women.

All regions, all countries, all people are equally important. This is a
health organization for the whole world. Our work must touch on the
lives of everyone, everywhere. But we must focus our attention on the
people in greatest need.

The people of Africa carry an enormous and disproportionate burden of
ill health and premature death. The health of the people of Africa must
therefore be the key indicator of the performance of WHO.

The health of women must be the other key indicator =96 and I do not mean
just maternal health. Women do much more than have babies.
Unfortunately, their activities in households and communities, coupled
with their low status, make them especially vulnerable to health
problems =96 from indoor air pollution and multiple infectious diseases
to violence.

Yet evidence from many sources also shows that women are agents of
change =96 for families, the workforce, and entire communities. The
health of children largely depends on the health of women. As mothers,
as sisters, as aunts and as grandmothers in the home. As carers, as
teachers and as health workers in the community. And I have been all of
these - except a grandmother!

Reducing health problems in women and empowering them will result in a
dramatic increase in health-promoting behaviours =96 right where it
counts most.

People matter most. I believe that is why the WHO Constitution begins
with such a clear statement =96 =93the enjoyment of the highest attainable
standard of health is one of the fundamental rights of every human
being=94.

It is also why the Constitution emphasizes the links between health,
happiness, harmonious relations and security.

Improvements in the health of the people of Africa and the health of
women are key indicators of the performance of WHO. Our commitment to
results is only relevant if we can demonstrate an impact in these two
populations.

Mr President,

Attaining these results for health means addressing six core issues:
health development, security, capacity, information and knowledge,
partnership, and performance.

The first two issues deal with fundamental needs: for health
development and health security. Poverty and insecurity are two of the
greatest threats to =93harmony=94 =96 a word at the core of the WHO
Constitution, but one we rarely hear today. I would like to use it
more. Harmony is a measure of civilization. Health is intrinsically
related to both development and security, and hence to harmony.

The next two issues are strategic: capacity building =96 particularly
strengthening health systems =96 and information and knowledge. This
means getting the evidence right and setting the agenda for research
and development.

The remaining two issues are operational: managing partnerships and
improving WHO performance.

This a simple way to look at a complex job: two fundamental health
needs, two main strategies for meeting the needs, and two operational
approaches for achieving results in countries. These six issues are
interrelated and work in synergy. Not all present the same level of
challenge =96 which is good, in a way, as it helps us sharpen priorities
and decide where we need to invest our energy.

Health development forms the core of the Millennium Development Goals.
I am passionately committed to the achievement of these goals. But let
us not limit health development to the MDG targets for the health of
women and children, for turning back the epidemics of HIV, malaria and
TB, for increasing access to essential drugs.

We must also address reproductive health, violence and injuries, and
the growing burden that chronic diseases place on development =96 heart
disease, stroke, cancer, diabetes, mental illness and others.

We must accelerate initiatives in safer pregnancy, integrated
management of childhood illness and immunization. We will enhance
efforts to reach the target of universal access to HIV treatment,
prevention and care. We will build greater momentum to control malaria,
TB and neglected infectious diseases.

We will complete polio eradication. We will scale up efforts to control
tobacco, including full implementation of the Framework Convention on
Tobacco Control. Our support to implement the Global Strategy on Diet,
Physical Activity and Health will increase.

Health security brings benefits at both the global and community
levels. New diseases are global threats to health that also cause
shocks to economies and societies. Defence against these threats
enhances our collective security. Communities also need health
security. This means provision of the fundamental prerequisites for
health: enough food, safe water, shelter, and access to essential
health care and medicines. These essential needs must also be met when
emergencies or disasters occur.

For global health security, I share your deep concern about the looming
threat of an influenza pandemic. We have strong new International
Health Regulations coming into force next year. We already have in
place strong and efficient mechanisms for global outbreak alert and
response already in place. These have been tested and proven effective,
most recently by SARS and avian influenza.

But these international mechanisms are not enough. The needs are
national as well as global. We will support countries in building
essential capacity in prevention, preparedness, response and
rehabilitation.

Improving health development and health security means improving health
systems. For outbreaks, the international community will not be
securely defended until all countries have core surveillance and
response capacities in place. The global surveillance system must have
no gaps or weak spots.

Health systems are the tap root for better health. All the donated
drugs in the world won=92t do any good without an infrastructure for
their delivery. You cannot deliver health care if the staff you trained
at home are working abroad.

When we talk about capacity, we absolutely must talk about the
importance of primary health care. It is the cornerstone of building
the capacity of health systems. It is also central to health
development and to community health security.

I plan to promote integrated primary health care as a strategy for
strengthening health systems. The reason is simple: It works. This is
the only way to ensure fair, affordable, and sustainable access to
essential care across a population. We have the evidence. I have
experienced this personally.

During my tenure in Hong Kong, I introduced primary health care from
the diaper to the grave. I focused on health promotion and disease
prevention, with special emphasis on self-care and healthy lifestyles.
During my time at WHO, I have visited countries representing a
diversity of economies, cultures, and health systems, often in
transition. I have learnt many lessons and have much experience to
share.

The world is not =96 all by itself =96 going to become a fair place as far
as health is concerned. Progress in medicine races ahead, yet resources
for public health grow more slowly. This leads to further imbalances
across the globe =96 some people leading ever longer and healthier lives,
others dying prematurely from preventable causes. This is not a healthy
situation =96 for populations or world security.

I have heard about the importance of primary health care repeatedly
during my visits to Latin America, Africa, Europe and Asia. Many
countries in Africa face the challenge of rebuilding social support
systems. Others in central Asia and Eastern Europe are undergoing
transition from planned to market economies. They want WHO support.
They want to make sure that equitable and accessible systems built on
primary health care are not sacrificed in the process. They reminded me
that traditional medicine is an important component that needs to be
addressed. I agree.

As Director-General I will address, as a matter of urgency, the problem
of outward migration of health staff. The problem is critical, but not
insurmountable.

On information and knowledge, it is critical to get the evidence right.
This is something WHO has always done well, but can do even better. The
challenge here is to make evidence have the right impact. We need
evidence to support countries as they establish their own priorities
and select the best strategies for reaching them.

I will integrate WHO=92s research activities to more strategically
address a common health research agenda. I will strengthen the
legitimacy, quality, and efficiency of our policy development
processes. I want to establish a global health observatory to collect,
collate and disseminate data on priority health problems.

When we have these evidence-based instruments, the fifth component,
working in partnerships, becomes much easier. Today, collaboration to
achieve public health goals is no longer simply an asset. It is a
critical necessity. WHO needs to develop an approach to collaboration
that emphasizes management of diversity and complexity.

We will continue to engage strategically in partnerships for health,
strengthening relationships with civil society and the private sector,
and creating greater alignment between partnerships. I will work
closely with our partners in the United Nations system to bring about
reforms that enhance the effectiveness of the UN =96 especially at the
country level.

Performance is the final component, and here we face the challenge of
making WHO perform more efficiently and effectively, getting all levels
of WHO to work more cohesively, and motivating staff. I believe that
WHO leads the UN in terms of results-based management, but there is
still some way to go to improve accountability and transparency.

I will also accelerate human resource reform to build a work ethic
within WHO that is based on competence, and pride in achieving results
for health.

Mr President,

As I have said, I am immensely proud to work for WHO. This organization
is among the most influential of all the United Nations agencies. Our
health mandate is a huge responsibility, but it also brings us four
unique assets. This is the source of our strength.

First, health is of universal concern. The issues we address are of
interest to every person on earth. They interest every Member State =96
hence the need for a health agency such as this one. Every major
newspaper, every big news site on the internet has a health section.

Whether we battle an outbreak or recommend a heart-healthy diet,
announce a deadly new strain of TB, immunize children, or show a link
between a chemical and cancer, this work interests the public and the
press immensely.

This makes our work matter and gives us universal relevance. As a
leading newspaper noted just last week, WHO has a truly comprehensive
global mandate.

Second, we have the scientific method on our side. The problems within
the mandate of WHO are subject to scientific scrutiny, and we have
powerful methodologies for getting proof. We can catch a causative
agent red-handed under a microscope, and nail the culprit down at the
molecular level.

Powerful epidemiological tools allow us to link lifestyle factors to a
increased risk of disease. We have the strength of the social sciences
for addressing the many problems with a behavioural component. We can
prove that an agent causes a disease, a drug cures it, or a vaccine
prevents it. We can know. We can prove.

This gives us our technical authority. We can be utterly convincing in
our arguments, absolutely authoritative in our guidance.

Third, our work is based on a clear and common value system. We share
the strong ethical foundation of the health profession. This is a
caring, healing, and science-based profession dedicated to the
prevention and relief of human suffering. This gives us our moral
authority, and a most noble system of ethical values

Finally, because the determinants of health are so broad, we can lead a
multi-pronged drive for health development and security that includes
many sectors other than health. This gives us our engagement.

This gives us the power to go after the root causes of the problems we
face. To build the foundation for good health for large populations in
a long-lasting way. To move from a curative to a preventive approach.
To use health as the lever for making this world a better place for all
of humanity.

We can do it.

When I think about these unique assets, I get a clear picture of what
WHO must do, what we can do, and what we should not do.

Science and ethics tell us what we must do. When we know =96 with solid
proof =96 the size of a problem and its cause, and when we have tools for
prevention, treatment, or cure, we have a moral imperative to act. I
have mentioned the Millennium Development Goals. Reaching these, and
other health-related targets you have adopted, is another thing that
WHO must do.

WHO must also act when a health problem is neglected. We have several
exciting initiatives that are making progress against ancient tropical
diseases. These are diseases that ruin the lives of millions, often the
poorest of the poor.

Here is another thing we must do. We must act when the problem is great
but we don=92t yet have the tools. In 1950, the top three priorities at
WHO were sexually transmitted diseases, malaria, and TB. Substitute
HIV/AIDS for sexually transmitted diseases, and things have changed
very little.

WHO must influence the research and development agenda. For these and
other diseases, we will not be able to make major strides forward until
we have new vaccines, new drugs and new diagnostic tools. In addition,
we must find the right balance between the protection of intellectual
property rights and access to affordable essential medicines. This is
not easy! But we cannot be evasive.

In terms of what WHO can do, we can magnify our impact by using our
relevance, our scientific authority, our ethics, and our broad
engagement to set a global health agenda that makes compelling good
sense for all the many actors in public health today. That is, sister
UN agencies, NGOs, civil society, foundations, funding agencies,
development banks, and the private and public sectors. When we have
such an instrument, we can give greater cohesion to the multiple
partnerships working within countries.

Here is what I think we should not do. We must not spread our resources
too thin. The temptation is great. The determinants of health are
broad, and the opportunities are multiple.

We must know our comparative advantage and stick with activities that
WHO is uniquely well suited to perform. I have heard repeated calls for
WHO to concentrate on a set of core public health functions. We must
not duplicate the work of others. And we must not try to do everything
on our own.

I firmly believe that WHO should not follow a =93full menu=94 approach. But
we do need to see what=92s on the table and do our utmost to ensure that
public health gets a balanced diet. Again, we can do this by using our
enviable technical expertise to guide the global agenda and ensure that
the best practices that science can devise are being followed.

WHO is not the implementing agency within countries, but can support
country priority setting, country ownership, and country stewardship. I
am convinced that countries know their own priorities. WHO can advise
on technically sound methods to address those priorities and help with
resource mobilization.

This, then, is the unique source of our strength as a health agency.
These assets give us the power to attain the most and the best results
for health.

Mr President,

My vision for WHO was sharpened tremendously over the last three
months, as I visited countries, spoke with health officials and health
workers in clinics, and witnessed what you are doing and what you are
achieving, often against incredible odds. This was an exciting and a
humbling experience.

To sharpen this vision further, I will consult with more countries and
more partners over the coming weeks and months. I want to tap the views
of experts from a broad range of countries, representing the diverse
disciplines and schools of thought. I want to hear from civil society
at the grass roots.

I look forward to discussions with staff in headquarters, and our
regional and country offices. I owe it to you =96 and the populations you
represent =96 to get things right. I will set out this refined and
sharpened vision when the Health Assembly convenes in May. In
concluding, I want to mention one additional dimension of my new job
description as I sign the contract. As we know, not all of the problems
faced by WHO in its efforts to improve world health are subject to
scientific scrutiny, or yield their secrets under a microscope. You
know the ones I mean: lack of resources and too little political
commitment. These are often the true =93killers=94.

This is what I can do personally: manage WHO in a way that attracts
resources, inspires confidence, and wins commitment. I will argue on
the side of humanity with compassion and passion. I will use the weight
of evidence and science and humanitarian ethics to persuade.

If we can influence people=92s hearts and minds =96 hearts based on ethical
principles and minds based on sound science. If we influence people=92s
hearts and minds, and inspire the confidence of donors, we are on a
good way towards fighting those two =93serial killers=94 =96 too little cas=
h,
too little caring.

This is something I can do.

I have just one final example. In the earliest years of this
organization, there was a cartoon strip about WHO, a serious adventure
story that ran in a number of newspapers. This Dr. WHO was a super-man
in a flowing white hospital coat and carrying a sparkling stethoscope.
He flew from country to country, battling murderous mutant microbes.
How things have changed!

Of course, WHO still has its epidemiologists who fly to outbreaks and
do what they can to stop murderous microbes. But these are by no means
the only heroes for health. In my 30 years of work in public health, I
have seen many. I observed many more during my recent visits to
countries.

The true heroes these days are the health workers with their healing,
caring ethic. They are determined to save lives and relieve suffering,
and they work with impressive dedication, often under difficult
conditions. The world needs many, many more of them.

I thank you for appointing me to this high office. And I also thank our
heroes =96 the health workers around the world =96 for all they are doing.

With all of us working together, we will do it. We will attain results
for health. We will make this world a healthier place.

Thank you.

------------
Thiru Balasubramaniam
Geneva Representative
CPTech
voice +41.22.791.6727
fax +41.22.723.2988
mobile +41 76 508 0997
thiru@cptech.org