Madam President, excellencies, honourable ministers, distinguished delegates, ladies andgentlemen,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 quicklyfollowed by an oil crisis, a debt crisis, an economic recession, and the imposition of structuraladjustment programmes, which forced governments to cut budgets for social services, includinghealth.The 1980s became known as the “lost decade for development”. After a long span of steadyprogress, large parts of the developing world slid back into deeper poverty. Health services, starved offunds, began to crumble.That damage was inherited by the next decade. With few exceptions, progress in public healthwas 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 “goldenage for health development”. And rightly so. For the first time, health moved to the top of thedevelopment agenda, thanks to the work of Dr Brundtland, including the report she commissioned onmacroeconomics and health.At the start of the decade, the Millennium Development Goals showed how much the perceptionof 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 healthagenda 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 childhoodillness.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 offinancing health development, like the GAVI Alliance, the Global Fund to Fight AIDS, Tuberculosisand Malaria, and UNITAID.
The decade is over, and some observers will tell you that the golden age for health developmenthas also come to an end. Bitter observers say what many suspect may be true. A financial crisisderailed the best chance ever to alleviate poverty and give this lopsided world greater fairness andbalance.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. Strikingachievements within countries make me optimistic. The unprecedented momentum for better healththat marked the start of this century continues, though on a different footing, sometimes on an evensurer footing.Ladies and gentlemen, time and time again, we see the importance of national ownership andleadership. India would never have been able to dramatically change the prospects for polioeradication without full government ownership of the programme. The Government of India deservesour congratulations for this monumental achievement.Ghana’s commitment to guinea-worm eradication shrunk the map to its last outpost, in SouthSudan. 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, isleading a group of eight neighbouring African countries in a joint effort to eliminate malaria within thenext few years. WHO has produced a complete set of technical manuals, for testing, treating, andtracking, 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/WHOinitiative to build the country’s capacity to respond to outbreaks and natural disasters. This is asplendid example of a whole-of-government approach, with more than 30 government sectors anddepartments working together to build resilience.In its fight to wrap a deadly product in a plain package, Australia leads resistance to the tobaccoindustry’s latest onslaught of aggressive tactics. No government seeking to introduce measures thatprotect the health of its citizens should be intimidated by an industry, especially by one with thereputation 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 anequal footing. The result is a pioneering framework that extends traditional cooperation in the healthrelatedpublic sectors to include annual contributions and firm commitments from private industry, inthe name of health.Given my commitment to women, I am grateful to the Nordic countries and Canada for theirunwavering promotion of women’s empowerment, gender equity, and human rights, and for leadingby 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 themomentum for better health. These countries have become the biggest suppliers of essentialmedicines, in affordable generic form, to the great benefit of the developing world. BRICS countriesalso offer an alternative model for health development, including technology transfer, based more onequal partnerships than on the traditional donor-recipient model.Some of these countries need support in upgrading quality standards and improving regulatorycontrol. WHO is providing this support. Last year, after extensive technical collaboration, WHOprequalified China’s State Food and Drug Administration. Once individual vaccines are prequalifiedby WHO, the country’s capacity to produce a large number of vaccines at very low prices willrevolutionize vaccine supplies and their prices.I am further encouraged by the high place health is given in many regional political andeconomic unions, and by international organs.Last November, I addressed members of the United Nations Security Council. I drew theirattention to the threat posed by emerging and epidemic-prone diseases, and reassured them. WHO usesa sophisticated electronic surveillance system to gather disease intelligence in real time. We are rarelytaken by surprise. WHO can mount an international response within 24 hours. This is because of yoursupport through the Global Outbreak Alert and Response Network, but also the capacity of ourcountry offices to get visas, move supplies through customs, and coordinate every step of the way withthe Ministry of Health. No other agency can do this.You have before you a report on progress in building the core capacities needed to implementthe International Health Regulations (2005). I look to you for further guidance and advice as we workto see the IHR fully implemented.Ladies and gentlemen, we see WHO leadership at work, often bringing outsized results forsmall but smart investments.Africa’s new meningitis vaccine, developed in a project coordinated by WHO and PATH, isbeing rolled out, promising to end seasonal epidemics in Africa’s meningitis belt. The payback will beenormous. A single case of meningitis can cost a household the equivalent of three to four months ofincome. Mounting an emergency immunization campaign to control an epidemic can absorb as muchas 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 preventivetreatments for schistosomiasis10-fold, reaching 100 million treatments per year by 2016.WHO administers the distribution of the majority of drugs donated to control the neglectedtropical diseases. With the January commitment, WHO is now in a position to protect all school-agechildren in Africa at risk of schistosomiasis.We can blanket this part of the world with medicines that rid every schoolchild of worms andeggs, parasites that interfere with their learning, impair cognitive development, and compromise theirnutritional 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 fordiagnosing active tuberculosis. Last week, the country with the largest use of these tests, especially byprivate practitioners, announced legislation banning the tests nationwide. More than a million of thesemisleading blood tests are carried out each year, often at great danger and great cost to patients, whomay 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, morethan 60 countries have approached WHO seeking technical support for their plans to move towardsuniversal coverage.What we are seeing goes against the historical pattern, where social services shrink when moneygets tight. I think this drive to expand coverage is a powerful signal. Despite deepening financialausterity, 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 oneoverarching conclusion. Universal health coverage is the single most powerful concept that publichealth has to offer.Universal coverage is relevant to every person on this planet. It is a powerful equalizer thatabolishes distinctions between the rich and the poor, the privileged and the marginalized, the youngand 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 duringwhat many regard as an especially dismal time. They also provide guidance on strategies andapproaches 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, anduniversal coverage. Shift to thrift. Develop a thirst for efficiency and an intolerance of waste. When agovernment commits itself to universal coverage, it takes a hard look at waste and inefficiency. Itshifts to thrift. At the international level, this means making good use of initiatives like theInternational Health Partnership Plus and Harmonization for Health in Africa. This meansstreamlining and integrating health programmes, as is being done with plans to ensure that every babyis born HIV-free. This means putting countries in the driver’s seat, giving them full ownership of whatis being done for the health of their people. This is how a government earns the trust and confidence ofits citizens, the voters. This means using WHO country offices as a resource for policy dialogue andcoordination, 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. Goodaid aims to eliminate the need for aid.Second, as public expectations rise, costs soar, and budgets shrink, we must look to innovationas never before. And I mean the right kind of innovation. Innovation does the most good when itresponds 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, strategicinnovation that sets out to develop a game-changing intervention, and makes ease of use andaffordable price explicit objectives. We are seeing a new wave of innovation that, I believe, thecommissioners on Social Determinants of Health would welcome. It looks not just at the causes ofpreventable deaths, but at the real reasons behind these causes. Let me express appreciation for theoutcome 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 arethese: 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 alow-cost simplified way to deliver babies, and protect mothers, when labour is prolonged. It promisesto transfer life-saving capacity to rural health posts, which almost never have the facilities and staff toperform a C-section. If approved, the Odon device will be the first simple new tool for assisteddelivery since forceps and vacuum extractors were introduced centuries ago.As we promote primary health care and universal coverage, we must not let a deterioratingeconomic outlook compromise the quality of clinical care. Primary health care is not cheap, and itmust not be a “B-team” version of what people get when they pay for private care. We must neverforget 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 peopleworldwide each year. To address this problem, WHO adapted a simple checklist used by pilots in theairline industry, one of the safest industries in the world. The WHO surgical safety checklist wasintroduced in 2008 and has since been widely applied, significantly reducing surgical errors. Studiessuggest that, if fully implemented, nearly half of those one million deaths would be averted. Buildingon this success, WHO has developed a safe childbirth checklist to address the huge burden ofpreventable 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 deliveredin health facilities if the quality of care is substandard or even dangerous? A pilot study of thechecklist, conducted in India and published last week, demonstrated a 150% increase in adherence toaccepted clinical practices for maternal and perinatal care in an institutional setting. No additionalresource investments were made. Just a paper checklist, like pilots use. A large randomized controlledtrial is under way to quantify the impact on reducing morbidity and mortality, but results will takesome years. In the meantime, WHO will soon release the checklist as part of a call for collaborativeresearch.There is another good reason to promote frugal innovation. Unlike other areas of technologydevelopment, like computers and mobile phones, advances in medical products nearly always comewith greater complexity and a much higher price. The complexity increases the price further, as highlyskilled staff are needed.At some point we come up against a brick wall, where delivering care for noncommunicablediseases, especially cancer, or care for people with mental disorders, especially elderly people withdementia, becomes unaffordable, even in the world’s wealthiest countries. To counter this trend, WHOhas launched an initiative to develop appropriate assistive devices for the world’s rapidly ageingpopulations. These are things like mobile phones adapted for the visually impaired and robust low-costhearing aids.Affordability is important, but so are simplicity and ease of use, as this relieves some of thepressure 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 adisabling hearing impairment.My final advice is brief. Use research. Use science. Shape the research agenda and seize everyopportunity opened by new findings. WHO does this most conspicuously when it revises policy andtechnical guidance for HIV/AIDS, tuberculosis, and malaria. As just one example, evidence indicatesthat the elimination of mother-to-child transmission of HIV is entirely feasible, and this is now ouroperational goal. This is part of efficiency. Science makes the breakthroughs. Public healthoperationalizes them and leaps ahead.Ladies and gentlemen, the past year has seen some good news for health and we are right to beencouraged. 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 officialdevelopment 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 itsheavy burden behind us. Evidence continues to mount that antiretroviral therapy not only saves livesbut 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 antiretroviraltherapy will be met. We have good reason to believe that the United Nations target of having15 million people on treatment by 2015 will not be met.
In these difficult financial times, I see an extremely dangerous tendency to measure how muchhealth can be bought for a given amount of money. Saving a life with a vaccine is unquestionably farcheaper and more immediate than keeping someone with AIDS alive. It is also less demanding onhealth 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 tostop new infections in the first place. We have that opportunity, opened even wider by evidence of theeffectiveness 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 monitoringof global health trends. This monitoring tells us where we are making progress, but also which healththreats cast the biggest shadow over that progress. And this is the biggest one, the longest darkshadow: the relentless rise of chronic noncommunicable diseases.Last week’s World health statistics report created a stir, and rightly so. WHO data show thatrates of obesity nearly doubled in every region of the world from 1980 to 2008. Worldwide, one inthree adults has raised blood pressure. One in ten adults has diabetes. These are the diseases that taxhealth systems to the breaking point. These are the diseases that break the bank. These are the diseasesthat can cancel out the gains of modernization and development. These are the diseases that can setback poverty alleviation, pushing millions of people below the poverty line each year.Last year’s Political Declaration on noncommunicable diseases assigned a number ofresponsibilities 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 andcontrol, the utmost priority.Ladies and gentlemen, I have a final comment as we think together about WHO reform. I seethe role of WHO as that of a global health guardian, a protector and defender of health, including theright to health. WHO is a custodian of technical expertise, but also of values, like social justice andequity, including gender equity.We must never forget our value system. Never forget the people. Public health is trained incompassion 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 betterhealth.This happened most recently with human African trypanosomiasis. Late-stage sleeping sicknessis invariably fatal. Drugs are donated for treatment, but what good do they do if cases are detected toolate? Understanding this, the company donating the drugs also gives WHO the funds needed to supportactive screening: that is, to pay for the facilities, equipment, logistics, staff, and their training. Industrycommitment continues because my staff took the company’s CEO and senior executives on a field tripto Africa last month. These executives saw the people, the illness, the lumbar punctures under themango trees, the cases detected, and the medicines given. Seeing the people, being eye-to-eye withtheir misery, has great power to motivate the right kind of public–private partnership. Results buildtrust, and with trust, commitment escalates.Let me conclude by thanking Member States for so carefully and diligently shepherding changeas this Organization undergoes the most extensive reforms in its history. We all know that this is notan 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 somuch time in supporting the work of this Organization.I personally believe that WHO does great good in this world. By improving the Organization’soperational 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