14 September 1998
Regional Committee for the Western Pacific Forty-ninth session, Manila, Philippines

Statement by: Dr Gro Harlem Brundtland, Director-General



Distinguished Ministers,
Dr Han,
Colleagues,
Ladies and gentlemen,

It is a pleasure for me to be in Manila and to attend this Regional Committee for the Western Pacific Region .

The Regional Committee is truly regional - but it is also an integral part of WHO. WHO is complete - our identity is intact - our course is on target - only if we include the regional dimensions - only if we add them up. I see this as a main challenge - to make WHO one - not seven organizations - Geneva and the six Regional Offices.

The Western Pacific has 27 of WHO's 191 Member States and one Associate Member, yet the total population of this Region numbers around 1.6 billion, one third of the world population. Any major public health threat to the Western Pacific is also a threat and a concern to the rest of the world. Any major progress in this Region, as is the case in lymphatic filariasis elimination and in polio eradication, spells progress for the rest of the world.

Never have so many in this world had such opportunities for health. Never has our knowledge been so great. Never has there been such a stream of discoveries and scientific breakthroughs.

And yet - so much remains to be accomplished. People in the developing world carry over 90 per cent of the disease burden - with access to only I O per cent of the resources used for health. Changing this equation is the core of our challenge.

It is a real opportunity for me to be here to listen to your discussions and experiences. Let me take this opportunity to share with you two important perspectives for WHO's work as we enter a century where the people we are serving have a right to expect real progress towards Health for All.

First - we need to anchor our quest for better health in a broad perspective - drawing in other sectors of society so essential for the health of billions. Second - we in WHO - working with you - need to focus our work, become more targeted, more efficient and more in line with the real needs in our Member States.

We need a broader perspective: Health is not only a vital asset for each individual, it is the very core of human development. We cannot point to more doctors and more affordable drugs alone and say that this is what we need to change the course in our world.

The deep roots of global health challenges are still Inked to poverty and underdevelopment. Ill-health leads to poverty and poverty breeds ill-health. Unless we can help break that vicious circle, our efforts will matter only marginally.

We have to look ahead and show that health provides a real path to a better society. We have the evidence: Investing in health gives tangible results. Less social and economic costs. More human progress. Enhanced capacity for society to harness the ultimate resource of the 21 st century: The human resource .

You, Health Ministers already know. But we need to go beyond and tell the Heads of States, the Prime Ministers, and the Finance Ministers, that they are really Health Ministers themselves. Our mandate is to change the international agenda and put health at the very core of the development process.

We need to reach out and to work across sectors. Most determinants of better health lie outside the health system . They include better education, a cleaner and safer environment sustained reductions in poverty, a stop to armed conflict and excessive military expenditures.

I wish to applaud the Western Pacific Region for its "New Horizon's for Health"; a sound framework for addressing the interrelated factors that influence health and well-being. In this way, you are combining health promotion strategies, including health legislation, health sector reform, and healthy environments through health-promoting schools, health-promoting workplaces and healthy cities. This is the kind of leadership and sophisticated forward-looking planning that WHO needs to provide world-wide .

To succeed WHO also has to reach out. The whole notion of a specialized agency has little meaning in this interdependent world if we fail to integrate our efforts with the other stakeholders. I wish to invite all those who have real contributions to make to join us : our UN partners, the international financial institutions, the NGO community, the private sector, and the people itself. We need constructive relations with the private sector and industry - being clear about our respective roles, where they differ and where they complement each other.

What then, is the way ahead for WHO? To keep it short I see it as making a difference for people's health, for the Governments and for their ability to improve it.

We must secure better unity of purpose and better focus. We cannot do everything - but we should be very good at what we do - and ready to say that we cannot do all.

Let me take you through the main features of the change process. I have appointed a new senior management team at headquarters level. Five members from the South and five from the North.

Six are women and four are men. All WHO Regions are represented. Together it is a strong global team. People with first-class health experience - but also people with experience from other sectors of society.

WHO has dozens of good and skilled programmes and activities. But we need to develop a structure which Gan bind our efforts much more strongly together, which can cope with a changing world, and which the outside world can relate to.

At Headquarters we have grouped the programmes into nine clusters. There are the obvious ones: One on Communicable diseases, and one on Non-communicable diseases. Our fight against the communicable diseases - such as HIV/AIDS, polio, malaria, TB and leprosy - must go on with renewed dedication. At the same time we need to prepare for the epidemic of non-communicable diseases - now hitting the poor countries and putting their health systems under great strain.

Then, we need to relate to a complex world. The cluster that deals with Sustainable Development and Environmental Health will focus on the broader intersectoral perspectives, addressing the environment and other effects of globalization and world trade.

The cluster on Social Change and Mental Health will help us to better understand and address the health consequences of some major social transitions such as the ageing of our populations and the growing strain from mental disorders.

The cluster on Evidence and Information for Policy - an innovation aimed at assembling, analysing and advocating the best evidence and lessons learned from the health-related sectors - will enable us all to take better, more cost-effective and more equitable decisions.

The overriding target is this: To organize our work so that it has maximum impact where it matters most - at country level. This has been requested by our Governing Bodies, including your own delegations. Time has come for the Secretariat to respond.

A key to all our work is to contribute to Health Sector Development. I have told the Executive Board that unless what we do contributes to developing more sustainable health sectors, we should not consider becoming involved.

WHO Headquarters needs to link more closely with countries. I intend to establish more direct relations with the WHO country representatives, who are very important to the quality of our Organization. In a few months I will invite them all to Geneva to share their experience and see how relations can be made more beneficial for you.

We will build stronger bridges to our Member States - especially those in greatest need. This is a twoway challenge: We - in the Secretariat - must pull our act together, achieve better focus and efficiency. You - the Member States - must set clear priorities, report back to the Organization on the health status of your population, and take responsibility for the targets you set.

There will be a change in the way we work. Besides the clusters of activities, we will work on specific projects, focusing on selected health issues. These projects will be time-limited, cut across clusters and Regions, and frequently engage other partners.

We have launched two such projects since 21 July: Roll Back Malaria, and Tobacco Free Initiative. These projects are aimed at providing new opportunities for catalyzing resources for countries and Regions. More will come.

Changes are also being made in our budgets. At the World Health Assembly, Member States decided after long discussions to change the regional allocations and to increase resources from the regular budget going to Africa and Europe.

I know this will face the other Regions, this Region included, with some painful decisions, especially at times of financial and economic turmoil. I shall do everything I can, looking beyond the regular budget, to mobilize funds to support our activities, especially towards the countries in greatest need.

Let me then turn to some specific health challenges in this Region:

Let us talk about malaria.

In the Western Pacific Region, around 110 million people are at risk for malaria in 10 countries with unacceptably high incidence rates in several countries and a growing problem of increasing drug resistance.

I have pledged WHO's determination to engage in a renewed effort to Roll Back Malaria. The Project staff is currently preparing the work in close dialogue with the Regional Offices, and gradually with the countries concerned. I urge you to join us.

It is a complex task. We know eradication is not an option. But we also know we can substantially reduce mortality and morbidity. We are attacking malaria by focusing on strengthened health systems. And once we succeed in this - once health systems can deal more effectively with malaria - then our fight against other communicable diseases will benefit as well.

Let us talk about HIV/AIDS - another crucial challenge for the Western Pacific. The pandemic reached most countries in this Region relatively late, but it has spread rapidly. Infection rates are going up not only in the high-risk behaviour groups but also in the general population.

WHO will work more intensively on HIV/AIDS in all our programmes. In the year to come we will do all we can to lend our full support to UNAIDS as we serve as the Chair of the cosponsors. We will make every effort to support national initiatives. We will press for research on vaccines, for simple yet effective diagnostic tests, and for more equitable access to prevention and treatment - including antiretroviral therapies.

Let us talk about tuberculosis, now so closely linked to the HIV pandemic. More than 80 per cent of the TB burden in the Region is concentrated in two countries: China and the Philippines. The Directly Observed Treatment Short-Course (DOTS) strategy has been implemented in half of China and 10 per cent of the Philippines. Progress remains alarmingly slow. Failure to urgently address this situation will lead to further increase in the number of drug resistant cases.

We need new efforts in the struggle against TB, and WHO will demonstrate leadership - by placing our TB effort in a broader context by focusing on the health sector and by working more closely with other partners .

On another front the Western Pacific Region has achieved noticeable progress: there are great hopes that the Western Pacific will be the first Region to be entirely free of lymphaticfilariasis. As the drugs used in this endeavour also have a major effect on intestinal worms, dramatic improvement can be expected in terms of anaemia and malnutrition reduction, and improved growth and school attendance in children. We should acknowledge the support of the private industrial sector for this programme. We are seeing an emerging alliance for the control of communicable diseases in the South Pacific. WHO is ready for this partnership, not least in the fight against malaria and filariasis.

This is a success story - but we need to be on guard against new and emerging threats - different as they may be. Let me mention just two: We need to prepare to confront a new spreading of Dengue fever, not least in this county. And we need to deal with the millions and millions of landmines spread around the region, killing and mutilating young and old. Very shortly the 40th state will have ratified the Landmine convention - and then the convention will enter into force. On that day we shall all cheer - but then we need to get on with ridding the world of antipersonnel mines - and healing the wounds of the thousands and thousands who have been crippled.

In this Region, many countries are undergoing transition. Non-communicable diseases related to life style emerge as new priorities.

Let us talk about tobacco. For several years cigarette consumption throughout the Western Pacific has been steadily increasing. Annual Chinese cigarette consumption was 100 billion in the 1950s, 500 billion in 1980 and has been about 1 800 billion in recent years. Tobacco may kill about 100 million of the 300 million Chinese men now under twenty-nine years of age, with half these deaths in middle-age and half in old-age.

WHO cannot remain indifferent. We need to free our population - in particular the young - of the tobacco pandemic. Tobacco should not be advertized, subsidized or glamourized.

The goals of the Tobacco Free Initiative are to heighten global awareness with regard to the facts of the current and likely impact of tobacco in developed and in developing countries. We must galvanise public support and build new and innovative partnerships to address the problem at the local, national and global level.

I urge all the governments in the Western Pacific to continue strengthening their work in the area of tobacco control, and work even more closely with WHO as the Tobacco Free Initiative takes shape over the next few months. Substance use, particularly alcohol and tobacco, is a major health risk for many of the estimated 200-300 million indigenous and tribal people from around the world. We are in the middle of the United Nations Decade on Indigenous Peoples. The WHO Project on Indigenous Peoples and Substance Use aims at assisting indigenous peoples respond to the health risks and problems associated with substance use in their communities. Within the Region a number of indigenous communities are participating, including communities in Australia, and New Zealand.

Let us talk about polio.

To underscore the power of well co-ordinated world initiatives, it has now been a year and a half since the last wild poliovirus was found in Cambodia. However, before we can congratulate ourselves for a job so well done, we must remember that all the countries of the Region must maintain excellent surveillance for the years to come, until the day that the entire world is certified free of polio. I also ask that the countries of this Region continue their generous support for the countries which remain polio endemic.

Let us talk about reproductive health.

Among the most significant health challenges this Region faces is the burden of reproductive ill-health. The maternal mortality ratio remains higher than 100 per 100000 live births in 11 countries and areas and the infant mortality rate is higher than 50 per 1000 live births in four countries of the Region. In addition there are large disparities within countries.

As is the case throughout the world, the poor are affected most of all. No Region can afford such a drain on its human resources, and no Region can afford to neglect the health of women. Inequities such as these contribute to the downward spiral of ill-health and poverty. If we are to make a difference, we will have to find effective ways of addressing these problems, sharing the lessons learned and building on the experiences within the Region and beyond.

The Western Pacific office should be congntulated for its innovative and wide-ranging response to the challenges articulated in its Reproductive Health Strategy in the Regional Programme Statement for 2000-2001 . The whole of the Organization has a lot to learn from your experiences.

We have predictions on how the health situation may evolve. But behind the figures there are real people. I was told a moving story the other day of a woman - one of millions of Asian women - who illustrate how far Asia has come - and at the same time how many challenges that remain.

Her name is Kristita and she lives in Manila - a typical representative of the emerging middle class, struggling to get her three teenage sons to college. Kristita may have more in common with middle class families in Seoul, Oslo or Seattle than with her relatives of a generation ago. Yet the changes of modern life do not protect her of the diseases of poverty. Recently her aunt and two children were infected with tuberculosis. Earlier this year her youngest son barely survived a bout of Dengue fever that killed three of his classmates.

At the same time Kristita has to worry about the diseases that come with urban life. In February her 32-year-old cousin died of heart attack after he ignored repeated doctor's warnings to cut down on smoking and fatty foods. And she is fighting a constant battle with tobacco industry for the soul and the lungs of her sons.

Yes the challenges are complex. They require all of our attention.

To conclude, let us talk about health sector reform in the context of a Region undergoing a dual transition - one from predominantly young to predominantly middle-aged or old populations and another from infectious diseases to chronic diseases and disabilities. Kristita lives in the middle of the transitions - and it is in her interest and that of billions - that we have to act.

Many in this Region ask: How can we build sustainable health systems that can stand the test of changing times and economic constraints?

How can we ensure access to basic health services in situations where the base of public finance threatens to collapse?

Each country must choose its own path - based on its pattern of disease, its institutions, its resources, and the needs of its people. WHO will be there, assembling the evidence, reporting on successes and failures WHO will be there to give the best advice and advocate the best practice.

Market forces have led to enormous increases in productivity in many sectors of the world economy. But they have failed to achieve similar success in health. Industry will never become the key provider of primary health stations or the guarantor of health services to the poor. It cannot on its own define and certify universal standards of quality and safety, Neither will it ensure equitable and universal access to care and services.

Universal access to quality services is a bedrock principle which WHO and Governments must stand for. Governments should provide strategic leadership - by setting priorities and standards. There are limits to the care they can finance. But defining priorities, standards and limits requires evidence of which efforts are likely to be the most effective, have the best overall impact and reach the most people.

Government-financed services must come from the most efficient source. This may mean providers from the private sector. Or from NGOs. Governments should engage capacity for health development wherever it may be, to meet their responsibility to ensure universal access to care.

I believe we need to start a discussion on norms and standards, to define a "new universalism" - in other words, a new perspective and new ways to promote and achieve universal coverage. You are facing the challenges and you have to find answers in accordance with your own situation. But WHO will be there to support you.

Yes, the challenges are many, but so are the opportunities. Together with my colleagues, in Geneva, the Regional Directors and the Regional Offices and the many dedicated WHO Representatives we embark on a course into a new century where our determination is to make a difference.

I look forward to working with you, and hopefully to be able to report on progress when we gather at the Regional Committee next year.

Thank you.


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14 Sep, 1998