In remarks prepared for delivery to 35 Ministers of Health at the Pan American Sanitary Conference opening today, Dr. Brundtland said, "There are scores of unmet needs. But the health sector has a track record of success over the past half century; it is our mandate, yours and mine, to carry that record forward. Progress in the next century will depend on our ability to explore the potential of the human resource. We go nowhere unless we succeed in building healthy populations in healthy communities."
Emphasizing the need for a broad perspective on health, she said, "Important determinants of better health lie outside the health system. They include better education. A cleaner and safer environment. Sustained reductions in poverty. We simply cannot appreciate the health challenges by only focusing on the health sector."
Health workers, she noted, "are on the receiving front of society's problems and inequities, often left with dealing with the outcome of events. At the same time we know that making right and timely investments in health benefits society at large. You, the Health Ministers, already know. Together we need to go beyond and tell the Presidents, the Prime Ministers and the Finance Ministers that they are really Health Ministers themselves."
Dr. Brundtland, who took office as Director-General in July, said, "I believe we can succeed in putting health at the center of the development agenda. Not alone. But by gathering our evidence, by matching it with that of others, by becoming better advocates, and by reaching decision-makers with a convincing case. This requires new momentum and new methods of work." She cited the need for the message of health as investment to reach Finance Ministers and Heads of State.
WHO, she said, can be a stronger lead agency in health by entering into partnerships with stakeholders other key players in health, and civil society, emphasizing the Organization's comparative advantage. "WHO should focus on problems that cross boundaries, on generating and disseminating a global evidence base, on promoting research that goes beyond corporate or national agendas. That is how we can really be efficient and make a difference at a country level - in our technical work - and in our setting of norms and standards. That is how WHO will provide the intellectual and moral leadership required to ensure health for all."
Work with other agencies and sub-regional trade agreements, such as NAFTA and MERCOSUR, she said, "offer important opportunities for multi-sectoral action for health. They also invite us to develop better strategies for linking health and trade issues. These include conventional areas of concern, such as harmonization of occupational and environmental health standards. They also involve balancing our mandate to protect the health of people from potential hazards with the imperative to avoid using health regulations as trade barriers. And they include new areas that are increasingly becoming crucial as globalization advances, such as the trade in health-related services and products."
Dr. Brundtland said, "WHO will engage the private sector in constructive dialogue and this will be of critical importance with regard to the pharmaceutical sector. National and international drug policies should help extend access to essential drugs of good quality, safety, and efficacy. This requires strong national regulatory authority and intelligent government purchasing policies."
"National strategies," she said, " must ensure equity of access, rational use, and assured quality for existing drugs. Issues of drug financing and affordability are critical. At the same time, to meet pressing public health needs we need new drugs and vaccines. This is true for emerging diseases, but also true because of the serious threat from growing resistance to drugs for common killers such as tuberculosis, bacterial meningitis, and pneumonia. To develop new drugs we need innovative industry research, with appropriate incentives for innovation and protection of intellectual property rights."
Noting the shift in the global burden of disease from communicable to non-communicable diseases, which poses "an exceedingly hard challenge to health systems" in developing countries, she said that despite the gains achieved in the fight against communicable diseases, "this progress must not, however, lead to the illusion that infectious diseases are a problem of the past. What we see here, like in many other parts of the developing world, is the simultaneous presence of multiple challenges, involving both communicable and non-communicable problems."
"The Region of the Americas is facing this double burden of disease and injury. Most of the countries still suffer an epidemiological backlog of common infections, malnutrition and reproductive health problems. Without having fully solved these challenges, they are already facing the emerging problems represented by non-communicable diseases, new infections and the mounting epidemic of injury from accidents and violence," Dr. Brundtland said.
"Violence is a particularly serious challenge for Latin America," the region with the highest proportion of deaths and of disability-adjusted life years lost to violence, she said. "Together with a comprehensive preventive strategy, we must be ready to offer timely health care of high quality to the victims of violence."
"In the balance sheet of our century, inequality remains as one of the largest social debts," Dr. Brundtland said. "Contrary to common misconceptions, inequalities do not follow a simple dividing line whereby communicable diseases would be mostly the problem of the poor and noncommunicable ailments would affect the rest of the population. The brutal fact is that the poor suffer higher rates of both types of diseases. WHO has no choice but to address the double burden simultaneously. As we continue to improve case management, we must seriously focus on controlling risk factors. And let there be no secret: By far the most important is tobacco."
Dr. Brundtland called smoking probably the single most rapidly increasing cause of death in the Americas. "I am a doctor. I believe in science and evidence. Let me state it clearly: Tobacco is a killer. It should not be advertised, subsidized or glamorized. Adolescents should not be allowed to mortgage their lives to the seductive advertisements of the industry," she said. To cope with the challenge of tobacco, she said, "We will need funding from voluntary donations, governmental as well as the private sector."She asked the Ministers to "involve the highest levels of Government and the highest levels of opinion leaders in their efforts to build on the present momentum, secure commitment, and reap the significant health and economic benefits that can be achieved from a reduction in tobacco use."
"Breaking the vicious cycle linking poverty, illness, illiteracy and malnutrition constitutes the central challenge to development policy as the new millennium dawns. Health improvements underpin any strategy for creating an upward spiral where better health improves nutrition, facilitates education and enhances the productivity and incomes of the poor. And these gains will in turn lead to better health," Dr. Brundtland said. She cited tudies carried out in many parts of the world that conclude that health matters for economic performance, as do removing financial barriers to health care and assuring good quality of services.
To guide health sector reform and judge its success, Dr. Brundtland said, there should be three concrete goals: "Measurable reduction in the huge inequities that still plague us - inequities both within and across countries; sustained, measurable reduction in the burden of disease; and universal access to efficient health services that respect the needs and dignity of each individual."
"A key responsibility for Governments should be to secure access to care. Only the public sector can guarantee basic universal rights. That is a useful reminder in this year of the 50th Anniversary of the Declaration of Human Rights as well as of our own Constitution," she said.
"Universal access to quality services is a bedrock principle," Dr. Brundtland said. " Governments should provide strategic leadership -through setting priorities- accepting that there are limits to the care Governments can finance, limits that each country must decide for itself. But setting priorities and defining limits require knowledge of which efforts will make the best impact, reach the most people, and achieve the most effective results. WHO should be there to advise you in this process. The new universalism embraces all potential contributors to better health -public sector, private sector or NGOs. Provision of government financed service must come from the most efficient source, not necessarily from public sector providers."
WHO has started a major modernization of its information technology network, she told the Ministers, " which will enable us to link the six corners of the world by the push of a button, by voice or by image in real time. There will be better communication and there will be money saved from doing away with unnecessary travel."
Dr. Brundtland said she will establish closer relations with the private sector and with NGOs to explore common grounds in intensive efforts with tangible targets such as Roll Back Malaria and the Tobacco Free Initiative.
"The bottom line is this: We need to make WHO more user-friendly, more evidence-based -for you, the Member States, who need it most, so that you can get more out of your health policies. This is a process of hope. We can do better. We will do better," she said.
Saying the Pan American Sanitary Conference casts "a light of hope into the future of international health cooperation," she told the Ministers, "I am hopeful about the Region of the Americas. You represent the oldest regional health organization in the world. You can be proud of your achievements. Many of our concepts and practices in international health cooperation are the result of the vision and dedication of many generations of public health researchers and practitioners from the Americas. No doubt, the rest of the world will continue to look to the Americas for examples of an effective regional organization."
Despite health accomplishments, Dr. Brundtland said, "We must also look forward to the challenges that are already with us, many of which derive from the very progress that we achieved during the 20th century. Others are the result of the agenda that we have not been able to fulfill. Still others will emerge as unprecedented problems of the future, and we must be prepared today in order to anticipate them. These challenges are a call for action -evidence-based and value-driven. Together we can make a difference for health -today and in the times to come."
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