Keynote Address at the World Health Summit
Dr Margaret Chan, Director-General of the World Health Organization
11 October 2015
Excellencies, honourable ministers, distinguished participants, ladies and gentlemen,
The world has changed dramatically since the start of this century, when the Millennium Development Goals became the focus of international efforts to reduce human misery.
At that time, human misery was thought to have a discrete set of principal causes, likepoverty, hunger, poor water and sanitation, several infectious diseases, and lack of essential care during pregnancy, childbirth, and childhood.
The results of that focus, and all the energy, resources, and innovations it unleashed, exceeded the wildest dreams of many. It demonstrated the power of international solidarity and brought out the best in human nature.
Maternal and child mortality fell at the fastest rate in history, with some of the sharpest drops recorded in sub-Saharan Africa. Each day, 17,000 fewer children die than in 1990. AIDS reached a tipping point in 2014 when the number of people newly receiving antiretroviral therapy surpassed the number of new infections.
Since the start of the century, an estimated 37 million lives were saved by effective diagnosis and treatment of tuberculosis. Over the same period, deaths from malariadeclined by 60%. An estimated 6.2 million lives, mainly in young African children, were saved.
Drug donations by the pharmaceutical industry allowed WHO to reach more than 800 million people each year with preventive therapy for river blindness, lymphatic filariasis, schistosomiasis, and other neglected topical diseases. These are ancient, debilitating diseases that anchor more than a billion people in poverty. By reaching so many millions, we are paving the way for a mass exodus from poverty.
I would like to thank the German government, Chancellor Merkel, and other G7 leaders for putting these diseases on the global agenda. If we believe in poverty reduction, we must address these neglected diseases. I also thank the private sector for providing preventive medicines at no cost. This is how public-private partnerships work at their best.
Last month, the United Nations General Assembly finalized a new agenda for sustainabledevelopment. The number of goals has grown from 8 to 17, including one for health. The related targets increased 8-fold, from 21 to 169.
The factors that now govern the well-being of the human condition, and the planet that sustains it, are no longer so discrete. The new agenda will try to shape a very different world.
This is a world that is seeing not the best in human nature, but the worst: internationalterrorism, senseless mass shootings, bombings in markets and places of worship,ancient and priceless archaeological sites reduced to rubble, and the seemingly endless armed conflicts that have contributed to the worst refugee crisis since the end of the second World War.
Ladies and gentlemen,
Since the start of this century, newer threats to health have gained prominence. Like the other problems that cloud humanity’s prospects for a sustainable future, these newer threats to health are much bigger and more complex than the problems that dominated the health agenda 15 years ago.
All around the world, health is being shaped by the same powerful forces, like populationageing, rapid urbanization, and the globalized marketing of unhealthy products.
Under the pressure of these forces, chronic noncommunicable diseases have overtakeninfectious diseases as the world’s biggest killers. This shift in the disease burden has profound implications. It challenges the very way socioeconomic progress is defined.
Beginning in the 19th century, improvements in hygiene and living conditions were followed by vast improvements in health status and life-expectancy. Theseenvironmental improvements aided the control of infectious diseases, totally vanquishing many major killers from modern societies.
Today, the tables are turned. Instead of diseases vanishing as living conditions improve, socioeconomic progress is actually creating the conditions that favour the rise of noncommunicable diseases. Economic growth, modernization, and urbanization have opened wide the entry point for the spread of unhealthy lifestyles.
The world is ill-prepared to cope with NCDs. Few health systems were built to manage chronic if not life-long conditions. Even fewer doctors were trained to prevent them. And even fewer governments can afford to treat them.
In some countries, the costs of treating diabetes alone absorb from 25% to 50% of the entire health budget. As a recent Lancet Oncology Commission concluded, the costs of cancer therapy are becoming unaffordable, even for the wealthiest countries in the world. Many newly approved cancer drugs cost more than $120,000 per person per year.
The climate is changing. WHO’s recent estimate that air pollution kills around 7 million people each year has finally given health a place in debates about the consequences of climate change. Worldwide, this past July was the hottest since at least 1880, when records began. This year’s thousands of deaths associated with heat waves in India and Pakistan provide further headline evidence of the health effects of extreme weather events.
Antimicrobial resistance has become a major health and medical crisis. If current trends continue, this will mean the end of modern medicine as we know it. WHO warmly welcomes the G7 health ministers declaration and the commitment it makes to address this crisis in all its multiple dimensions.
No one working in public health should underestimate the challenges that lie ahead. These newer threats to health do not neatly fit the biomedical model that has historically guided public health responses. Their root causes lie outside the traditional domain ofpublic health.
The health sector acting alone cannot protect children from the marketing of unhealthy foods and beverages, persuade countries to reduce their greenhouse gas emissions, or get industrialized food producers to reduce their massive use of antibiotics.
The newer threats to health also lie beyond the traditional domain of sovereign nations accustomed to governing what happens in their territories. In a world of radically increased interdependence, all are transboundary threats.
The globalized marketing of unhealthy products respects no borders. By definition, a changing climate affects the entire planet.
As sharply illustrated by malaria, tuberculosis, and bacteria carrying the NDM-1 enzyme,drug-resistant pathogens are notorious globe-trotters. They travel well in infected air passengers and through global trade in food. In addition, the growth of medical tourism has accelerated the international spread of hospital-acquired infections that arefrequently resistant to multiple drugs.
We face other challenges. The poverty map has changed. Today, 70% of the world’s poor live in middle-income countries. This is a game-changing statistic. Growth in GDP has long been the yardstick for measuring national progress.
If the economy is doing well, where is the incentive to invest in equitable health care? The world does not need any more rich countries full of poor people.
Our world is profoundly interconnected and this, too, has consequences. The refugeecrisis in Europe shattered the notion that wars in faraway lands will stay remote. The Ebola outbreak shattered the notion that a disease of poor African nations will have no consequences elsewhere.
Ladies and gentlemen,
In the most dramatic and tragic way possible, the Ebola outbreak focused international attention on the need to invest in health systems, especially in fragile and vulnerable states.
WHO welcomes the G7 commitment to act on lessons learned from Ebola. I welcome, in particular, the emphasis it places on strengthening health systems as a first line of defence against the infectious disease threat.
As noted, the goal is to build resilient and sustainable health systems that offer quality, comprehensive care and aim to progressively achieve universal health coverage.
The attention given to health systems is a most welcome focus that was not presentwhen the Millennium Development Goals were agreed 15 years ago.
The global health initiatives that brought such spectacular results did so largely through the delivery of commodities, like bednets, vaccines, and cocktails of medicine. Confronted with weak health systems, the initiatives often built their own parallel systems for procurement, delivery, financial management, and reporting.
Fortunately, many development partners now recognize that virtually all health targets on the new development agenda need a well-functioning and inclusive health system to achieve sustainable results.
Last month, 267 prominent economists from 44 countries published a declaration in the Lancet. That declaration called on global leaders to prioritize a pro-poor pathway to universal health coverage as an essential pillar of sustainable development.
The economic arguments for doing so are compelling. UHC transforms livelihoods as well as lives, and works as a poverty-reduction strategy. The economic benefits of investing in UHC are estimated to be more than ten times greater than the costs.
The evidence is now overwhelming that providing quality health services free at the point of delivery helps end poverty, boosts growth, and saves lives. UHC cushions shocks on communities when crises occur, whether these arise from a changing climate or a runaway virus.
Under normal conditions, UHC builds cohesive and stable societies and underpins economic productivity. These are valued assets for every country in the world.