Madam President, excellencies, honourable ministers, distinguished delegates, ladies and
gentlemen,
This is the sixth time I have addressed the Health Assembly in my capacity as Director-General.
I still get nervous. But I do have some important messages to convey.
In public health, decades sometimes acquire labels. The 1970s were a decade of hope,
culminating in the Health for All movement under Dr Mahler’s leadership. That hope was quickly
followed by an oil crisis, a debt crisis, an economic recession, and the imposition of structural
adjustment programmes, which forced governments to cut budgets for social services, including
health.
The 1980s became known as the “lost decade for development”. After a long span of steady
progress, large parts of the developing world slid back into deeper poverty. Health services, starved of
funds, began to crumble.
That damage was inherited by the next decade. With few exceptions, progress in public health
was slow during the 1990s, with health viewed as an expenditure rather than an investment.
The first decade of the 21st century has also acquired a label. Many describe it as the “golden
age for health development”. And rightly so. For the first time, health moved to the top of the
development agenda, thanks to the work of Dr Brundtland, including the report she commissioned on
macroeconomics and health.
At the start of the decade, the Millennium Development Goals showed how much the perception
of health had changed, from a drain on resources to a driver of socioeconomic progress.
In that golden decade, governments, in both donor and recipient countries, made the health
agenda a top priority. Money for health development more than tripled. Substantial results followed,
with a particularly strong impact on deaths from HIV/AIDS, tuberculosis, malaria, and childhood
illness.
The Millennium Development Goals unleashed the best in human ingenuity and creativity,
leaving a legacy of innovations. The list is long. It includes new vaccines, medicines, and diagnostics,
new ways of stimulating research and development for diseases of the poor, and new ways of
financing health development, like the GAVI Alliance, the Global Fund to Fight AIDS, Tuberculosis
and Malaria, and UNITAID.
The decade is over, and some observers will tell you that the golden age for health development
has also come to an end. Bitter observers say what many suspect may be true. A financial crisis
derailed the best chance ever to alleviate poverty and give this lopsided world greater fairness and
balance.
I strongly disagree. I believe the best days for health are ahead of us, not behind us.
It is true that money is tight and the future of the world economic situation looks uncertain.
Health officials, development partners, and WHO are watching money closely. Money is important,
but many other factors drive progress in public health.
During my recent visits to countries, I have seen inspiring examples of success. Striking
achievements within countries make me optimistic. The unprecedented momentum for better health
that marked the start of this century continues, though on a different footing, sometimes on an even
surer footing.
Ladies and gentlemen, time and time again, we see the importance of national ownership and
leadership. India would never have been able to dramatically change the prospects for polio
eradication without full government ownership of the programme. The Government of India deserves
our congratulations for this monumental achievement.
Ghana’s commitment to guinea-worm eradication shrunk the map to its last outpost, in South
Sudan. During the first quarter of 2012, cases of this disease dropped 67% compared with last year,
and now number just over 100.
I visited Namibia in April. That country’s minister of health, an expert in vector control, is
leading a group of eight neighbouring African countries in a joint effort to eliminate malaria within the
next few years. WHO has produced a complete set of technical manuals, for testing, treating, and
tracking, to guide them on their way.
These countries are ambitious. They are determined. Their eyes are wide open to the challenge,
but the chances of success are good.
Last month, I also visited Oman, where I learned about the outcome of a European Union/WHO
initiative to build the country’s capacity to respond to outbreaks and natural disasters. This is a
splendid example of a whole-of-government approach, with more than 30 government sectors and
departments working together to build resilience.
In its fight to wrap a deadly product in a plain package, Australia leads resistance to the tobacco
industry’s latest onslaught of aggressive tactics. No government seeking to introduce measures that
protect the health of its citizens should be intimidated by an industry, especially by one with the
reputation of Big Tobacco.
During negotiations on pandemic influenza preparedness, Indonesia, joined by many others,
pushed for a fairer and more equitable system that shares responsibilities and access to benefits, on an
equal footing. The result is a pioneering framework that extends traditional cooperation in the healthrelated
public sectors to include annual contributions and firm commitments from private industry, in
the name of health.
Given my commitment to women, I am grateful to the Nordic countries and Canada for their
unwavering promotion of women’s empowerment, gender equity, and human rights, and for leading
by example.
Several recent studies have advised the international community to look to BRICS countries,
namely Brazil, the Russian Federation, India, China, and South Africa, as a way to maintain the
momentum for better health. These countries have become the biggest suppliers of essential
medicines, in affordable generic form, to the great benefit of the developing world. BRICS countries
also offer an alternative model for health development, including technology transfer, based more on
equal partnerships than on the traditional donor-recipient model.
Some of these countries need support in upgrading quality standards and improving regulatory
control. WHO is providing this support. Last year, after extensive technical collaboration, WHO
prequalified China’s State Food and Drug Administration. Once individual vaccines are prequalified
by WHO, the country’s capacity to produce a large number of vaccines at very low prices will
revolutionize vaccine supplies and their prices.
I am further encouraged by the high place health is given in many regional political and
economic unions, and by international organs.
Last November, I addressed members of the United Nations Security Council. I drew their
attention to the threat posed by emerging and epidemic-prone diseases, and reassured them. WHO uses
a sophisticated electronic surveillance system to gather disease intelligence in real time. We are rarely
taken by surprise. WHO can mount an international response within 24 hours. This is because of your
support through the Global Outbreak Alert and Response Network, but also the capacity of our
country offices to get visas, move supplies through customs, and coordinate every step of the way with
the Ministry of Health. No other agency can do this.
You have before you a report on progress in building the core capacities needed to implement
the International Health Regulations (2005). I look to you for further guidance and advice as we work
to see the IHR fully implemented.
Ladies and gentlemen, we see WHO leadership at work, often bringing outsized results for
small but smart investments.
Africa’s new meningitis vaccine, developed in a project coordinated by WHO and PATH, is
being rolled out, promising to end seasonal epidemics in Africa’s meningitis belt. The payback will be
enormous. A single case of meningitis can cost a household the equivalent of three to four months of
income. Mounting an emergency immunization campaign to control an epidemic can absorb as much
as 5% of a country’s entire health budget.
WHO leadership brought the neglected tropical diseases from obscurity into the limelight.
These Cinderella diseases, long ignored and underappreciated, are a rags-to-riches story.
In January, a pharmaceutical company pledged to step up its contribution of preventive
treatments for schistosomiasis10-fold, reaching 100 million treatments per year by 2016.
WHO administers the distribution of the majority of drugs donated to control the neglected
tropical diseases. With the January commitment, WHO is now in a position to protect all school-age
children in Africa at risk of schistosomiasis.
We can blanket this part of the world with medicines that rid every schoolchild of worms and
eggs, parasites that interfere with their learning, impair cognitive development, and compromise their
nutritional status. This is a gift to their health, but also to the education and nutrition sectors.
Last year, WHO recommended a ban on inaccurate and costly commercial blood tests for
diagnosing active tuberculosis. Last week, the country with the largest use of these tests, especially by
private practitioners, announced legislation banning the tests nationwide. More than a million of these
misleading blood tests are carried out each year, often at great danger and great cost to patients, who
may have to pay up to US$ 30 per test. Think of what we are saving.
Following publication of the The world health report 2010 on health system financing, more
than 60 countries have approached WHO seeking technical support for their plans to move towards
universal coverage.
What we are seeing goes against the historical pattern, where social services shrink when money
gets tight. I think this drive to expand coverage is a powerful signal. Despite deepening financial
austerity, the will to do the right thing, the fair thing, for people’s health prevails.
All of these examples, all of my personal experiences over the past five years, bring me to one
overarching conclusion. Universal health coverage is the single most powerful concept that public
health has to offer.
Universal coverage is relevant to every person on this planet. It is a powerful equalizer that
abolishes distinctions between the rich and the poor, the privileged and the marginalized, the young
and the old, ethnic groups, and women and men.
Universal health coverage is the best way to cement the gains made during the previous decade.
It is the ultimate expression of fairness. This is the anchor for the work of WHO as we move forward.
Ladies and gentlemen, these examples give me, personally, great cause for optimism during
what many regard as an especially dismal time. They also provide guidance on strategies and
approaches that help maintain the momentum for health in the years ahead.
I can suggest three general lines of advice.
First, get back to the basics, like primary health care, access to essential medicines, and
universal coverage. Shift to thrift. Develop a thirst for efficiency and an intolerance of waste. When a
government commits itself to universal coverage, it takes a hard look at waste and inefficiency. It
shifts to thrift. At the international level, this means making good use of initiatives like the
International Health Partnership Plus and Harmonization for Health in Africa. This means
streamlining and integrating health programmes, as is being done with plans to ensure that every baby
is born HIV-free. This means putting countries in the driver’s seat, giving them full ownership of what
is being done for the health of their people. This is how a government earns the trust and confidence of
its citizens, the voters. This means using WHO country offices as a resource for policy dialogue and
coordination, and for ensuring that aid for health development moves the country towards selfreliance.
Good aid is channeled in ways that strengthen existing infrastructures and capacities. Good
aid aims to eliminate the need for aid.
Second, as public expectations rise, costs soar, and budgets shrink, we must look to innovation
as never before. And I mean the right kind of innovation. Innovation does the most good when it
responds to societal concerns and needs, and not just to the prospects of making a profit. These days,
the true genius of innovation resides in simplicity. This is not rocket science. This is frugal, strategic
innovation that sets out to develop a game-changing intervention, and makes ease of use and
affordable price explicit objectives. We are seeing a new wave of innovation that, I believe, the
commissioners on Social Determinants of Health would welcome. It looks not just at the causes of
preventable deaths, but at the real reasons behind these causes. Let me express appreciation for the
outcome of last year’s meeting on social determinants held in Rio de Janeiro, Brazil.
Obstructed labour is a major killer of young women and adolescent girls. The real reasons are
these: poverty and health systems that are impoverished by lack of medicines, equipment, skilled staff,
and transportation. The Odon device, developed by WHO and now undergoing clinical trials, offers a
low-cost simplified way to deliver babies, and protect mothers, when labour is prolonged. It promises
to transfer life-saving capacity to rural health posts, which almost never have the facilities and staff to
perform a C-section. If approved, the Odon device will be the first simple new tool for assisted
delivery since forceps and vacuum extractors were introduced centuries ago.
As we promote primary health care and universal coverage, we must not let a deteriorating
economic outlook compromise the quality of clinical care. Primary health care is not cheap, and it
must not be a “B-team” version of what people get when they pay for private care. We must never
forget the importance of high-quality clinical care. Here, too, frugal innovation helps.
Just a few years ago, WHO estimated that surgical errors were killing around one million people
worldwide each year. To address this problem, WHO adapted a simple checklist used by pilots in the
airline industry, one of the safest industries in the world. The WHO surgical safety checklist was
introduced in 2008 and has since been widely applied, significantly reducing surgical errors. Studies
suggest that, if fully implemented, nearly half of those one million deaths would be averted. Building
on this success, WHO has developed a safe childbirth checklist to address the huge burden of
preventable maternal and newborn deaths, especially in low-income settings.
What good does it do to offer free maternal care and have a high proportion of babies delivered
in health facilities if the quality of care is substandard or even dangerous? A pilot study of the
checklist, conducted in India and published last week, demonstrated a 150% increase in adherence to
accepted clinical practices for maternal and perinatal care in an institutional setting. No additional
resource investments were made. Just a paper checklist, like pilots use. A large randomized controlled
trial is under way to quantify the impact on reducing morbidity and mortality, but results will take
some years. In the meantime, WHO will soon release the checklist as part of a call for collaborative
research.
There is another good reason to promote frugal innovation. Unlike other areas of technology
development, like computers and mobile phones, advances in medical products nearly always come
with greater complexity and a much higher price. The complexity increases the price further, as highly
skilled staff are needed.
At some point we come up against a brick wall, where delivering care for noncommunicable
diseases, especially cancer, or care for people with mental disorders, especially elderly people with
dementia, becomes unaffordable, even in the world’s wealthiest countries. To counter this trend, WHO
has launched an initiative to develop appropriate assistive devices for the world’s rapidly ageing
populations. These are things like mobile phones adapted for the visually impaired and robust low-cost
hearing aids.
Affordability is important, but so are simplicity and ease of use, as this relieves some of the
pressure on specialized care and further reduces costs. Imagine the impact on well-being and quality o
life. In developing countries, WHO estimates that nearly 40% of people older than 65 years have a
disabling hearing impairment.
My final advice is brief. Use research. Use science. Shape the research agenda and seize every
opportunity opened by new findings. WHO does this most conspicuously when it revises policy and
technical guidance for HIV/AIDS, tuberculosis, and malaria. As just one example, evidence indicates
that the elimination of mother-to-child transmission of HIV is entirely feasible, and this is now our
operational goal. This is part of efficiency. Science makes the breakthroughs. Public health
operationalizes them and leaps ahead.
Ladies and gentlemen, the past year has seen some good news for health and we are right to be
encouraged. But there are at least two danger zones, and they are big ones.
Our traditional financial donors are under intense domestic pressure to demonstrate that official
development assistance is being wisely invested. Taxpayers and parliamentarians want to see quick,
tangible, and measurable results that demonstrate payback for the money. This can be dangerous,
especially for a disease like HIV/AIDS.
In a sense, we are in the best position ever to get ahead of this devastating epidemic and put its
heavy burden behind us. Evidence continues to mount that antiretroviral therapy not only saves lives
but is also a powerful preventive tool, reducing sexual transmission of HIV by as much as 96%.
Unfortunately, it is highly unlikely that the established goal of universal access to antiretroviral
therapy will be met. We have good reason to believe that the United Nations target of having
15 million people on treatment by 2015 will not be met.
In these difficult financial times, I see an extremely dangerous tendency to measure how much
health can be bought for a given amount of money. Saving a life with a vaccine is unquestionably far
cheaper and more immediate than keeping someone with AIDS alive. It is also less demanding on
health services. In my view, human life cannot be valued, or devalued, or discounted in this way.
These medicines are a lifeline for a lifetime. The only ethically acceptable exit strategy is to
stop new infections in the first place. We have that opportunity, opened even wider by evidence of the
effectiveness of male and female condoms, harm reduction, behaviour change, and male circumcision.
The critical question is this: will we seize this opportunity or let it slip away?
The second danger zone should be obvious to anyone who pays attention to WHO’s monitoring
of global health trends. This monitoring tells us where we are making progress, but also which health
threats cast the biggest shadow over that progress. And this is the biggest one, the longest dark
shadow: the relentless rise of chronic noncommunicable diseases.
Last week’s World health statistics report created a stir, and rightly so. WHO data show that
rates of obesity nearly doubled in every region of the world from 1980 to 2008. Worldwide, one in
three adults has raised blood pressure. One in ten adults has diabetes. These are the diseases that tax
health systems to the breaking point. These are the diseases that break the bank. These are the diseases
that can cancel out the gains of modernization and development. These are the diseases that can set
back poverty alleviation, pushing millions of people below the poverty line each year.
Last year’s Political Declaration on noncommunicable diseases assigned a number of
responsibilities to WHO. You have before you a report on the multiple steps WHO has taken to meet
these expectations. I can assure you: we are giving these diseases, and our role in their prevention and
control, the utmost priority.
Ladies and gentlemen, I have a final comment as we think together about WHO reform. I see
the role of WHO as that of a global health guardian, a protector and defender of health, including the
right to health. WHO is a custodian of technical expertise, but also of values, like social justice and
equity, including gender equity.
We must never forget our value system. Never forget the people. Public health is trained in
compassion and driven by passion. This will always be our strength, our true comparative advantage.
Persuading others to share this value system is another way to maintain the momentum for better
health.
This happened most recently with human African trypanosomiasis. Late-stage sleeping sickness
is invariably fatal. Drugs are donated for treatment, but what good do they do if cases are detected too
late? Understanding this, the company donating the drugs also gives WHO the funds needed to support
active screening: that is, to pay for the facilities, equipment, logistics, staff, and their training. Industry
commitment continues because my staff took the company’s CEO and senior executives on a field trip
to Africa last month. These executives saw the people, the illness, the lumbar punctures under the
mango trees, the cases detected, and the medicines given. Seeing the people, being eye-to-eye with
their misery, has great power to motivate the right kind of public–private partnership. Results build
trust, and with trust, commitment escalates.
Let me conclude by thanking Member States for so carefully and diligently shepherding change
as this Organization undergoes the most extensive reforms in its history. We all know that this is not
an easy process. But it must be done and it must be done right.
I would also like to thank Regional Directors and staff for their good work, dedication,
commitment to the Organization, and support for its reform.
I thank as well the Permanent Missions here in Geneva and their ambassadors for investing so
much time in supporting the work of this Organization.
I personally believe that WHO does great good in this world. By improving the Organization’s
operational effectiveness and strategically positioning its work, we can do more.
The world expects this, and needs this, from WHO.
We will not let the people down.
Thank you
