Best days for public health are ahead of us says WHO DirectorGeneralWord文档下载推荐.docx

Best days for public health are ahead of us says WHO DirectorGeneralWord文档下载推荐.docx

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Director-GeneraloftheWorldHealthOrganization

AddresstotheSixty-fifthWorldHealthAssembly

Geneva,Switzerland

21May2012

MadamPresident,excellencies,honourableministers,distinguisheddelegates,ladiesandgentlemen,

ThisisthesixthtimeIhaveaddressedtheHealthAssemblyinmycapacityasDirector-General.Istillgetnervous.ButIdohavesomeimportantmessagestoconvey.

Inpublichealth,decadessometimesacquirelabels.The1970swereadecadeofhope,culminatingintheHealthforAllmovementunderDrMahler’sleadership.

Thathopewasquicklyfollowedbyanoilcrisis,adebtcrisis,aneconomicrecession,andtheimpositionofstructuraladjustmentprogrammes,whichforcedgovernmentstocutbudgetsforsocialservices,includinghealth.

The1980sbecameknownasthe“lostdecadefordevelopment”.Afteralongspanofsteadyprogress,largepartsofthedevelopingworldslidbackintodeeperpoverty.Healthservices,starvedoffunds,begantocrumble.

Thatdamagewasinheritedbythenextdecade.Withfewexceptions,progressinpublichealthwasslowduringthe1990s,withhealthviewedasanexpenditureratherthananinvestment.

Thefirstdecadeofthe21stcenturyhasalsoacquiredalabel.Manydescribeitasthe“goldenageforhealthdevelopment”.Andrightlyso.

Forthefirsttime,healthmovedtothetopofthedevelopmentagenda,thankstotheworkofDrBrundtland,includingthereportshecommissionedonmacroeconomicsandhealth.

Atthestartofthedecade,theMillenniumDevelopmentGoalsshowedhowmuchtheperceptionofhealthhadchanged,fromadrainonresourcestoadriverofsocioeconomicprogress.

Inthatgoldendecade,governments,inbothdonorandrecipientcountries,madethehealthagendaatoppriority.Moneyforhealthdevelopmentmorethantripled.Substantialresultsfollowed,withaparticularlystrongimpactondeathsfromHIV/AIDS,tuberculosis,malaria,andchildhoodillness.

TheMillenniumDevelopmentGoalsunleashedthebestinhumaningenuityandcreativity,leavingalegacyofinnovations.Thelistislong.Itincludesnewvaccines,medicines,anddiagnostics,newwaysofstimulatingR&

Dfordiseasesofthepoor,andnewwaysoffinancinghealthdevelopment,likeGAVI,theGlobalFund,andUNITAID.

Thedecadeisover,andsomeobserverswilltellyouthatthegoldenageforhealthdevelopmenthasalsocometoanend.

Bitterobserverssaywhatmanysuspectmaybetrue.Afinancialcrisisderailedthebestchanceevertoalleviatepovertyandgivethislopsidedworldgreaterfairnessandbalance.

Istronglydisagree.Ibelievethebestdaysforhealthareaheadofus,notbehindus.

Itistruethatmoneyistightandthefutureoftheworldeconomicsituationlooksuncertain.Healthofficials,developmentpartners,andWHOarewatchingmoneyclosely.Moneyisimportant,butmanyotherfactorsdriveprogressinpublichealth.

Duringmyrecentvisitstocountries,Ihaveseeninspiringexamplesofsuccess.Strikingachievementswithincountriesmakemeoptimistic.

Theunprecedentedmomentumforbetterhealththatmarkedthestartofthiscenturycontinues,thoughonadifferentfooting,sometimesonanevensurerfooting.

Ladiesandgentlemen,

Timeandtimeagain,weseetheimportanceofnationalownershipandleadership.Indiawouldneverhavebeenabletodramaticallychangetheprospectsforpolioeradicationwithoutfullgovernmentownershipoftheprogramme.

ThegovernmentofIndiadeservesourcongratulationsforthismonumentalachievement.

Ghana’scommitmenttoguineawormeradicationshrunkthemaptoitslastoutpost,inSouthSudan.Duringthefirstquarterof2012,casesofthisdiseasedropped67%comparedwithlastyear,andnownumberjustover100.

IvisitedNamibiainApril.Thatcountry’sministerofhealth,anexpertinvectorcontrol,isleadingagroupof8neighbouringAfricancountriesinajointefforttoeliminatemalariawithinthenextfewyears.WHOhasproducedacompletesetoftechnicalmanuals,fortesting,treating,andtracking,toguidethemontheirway.

Thesecountriesareambitious.Theyaredetermined.Theireyesarewideopentothechallenge,butthechancesofsuccessaregood.

Lastmonth,IalsovisitedOman,whereIlearnedabouttheoutcomeofanEU/WHOinitiativetobuildthecountry’scapacitytorespondtooutbreaksandnaturaldisasters.Thisisasplendidexampleofawhole-of-governmentapproach,withmorethan30governmentsectorsanddepartmentsworkingtogethertobuildresilience.

Initsfighttowrapadeadlyproductinaplainpackage,Australialeadsresistancetothetobaccoindustry’slatestonslaughtofaggressivetactics.Nogovernmentseekingtointroducemeasuresthatprotectthehealthofitscitizensshouldbeintimidatedbyanindustry,especiallybyonewiththereputationofBigTobacco.

Duringnegotiationsonpandemicinfluenzapreparedness,Indonesia,joinedbymanyothers,pushedforafairerandmoreequitablesystemthatsharesresponsibilitiesandaccesstobenefits,onanequalfooting.Theresultisapioneeringframeworkthatextendstraditionalcooperationinthehealth-relatedpublicsectorstoincludeannualcontributionsandfirmcommitmentsfromprivateindustry,inthenameofhealth.

Givenmycommitmenttowomen,IamgratefultotheNordiccountriesandCanadafortheirunwaveringpromotionofwomen’sempowerment,genderequity,andhumanrights,andforleadingbyexample.

SeveralrecentstudieshaveadvisedtheinternationalcommunitytolooktoBRICScountries,namelyBrazil,theRussianFederation,India,China,andSouthAfrica,asawaytomaintainthemomentumforbetterhealth.

Thesecountrieshavebecomethebiggestsuppliersofessentialmedicines,inaffordablegenericform,tothegreatbenefitofthedevelopingworld.BRICScountriesalsoofferanalternativemodelforhealthdevelopment,includingtechnologytransfer,basedmoreonequalpartnershipsthanonthetraditionaldonor-recipientmodel.

Someofthesecountriesneedsupportinupgradingqualitystandardsandimprovingregulatorycontrol.WHOisprovidingthissupport.Lastyear,afterextensivetechnicalcollaboration,WHOprequalifiedChina’sStateFoodandDrugAdministration.

OnceindividualvaccinesareprequalifiedbyWHO,thecountry’scapacitytoproducealargenumberofvaccinesatverylowpriceswillrevolutionizevaccinesuppliesandtheirprices.

Iamfurtherencouragedbythehighplacehealthisgiveninmanyregionalpoliticalandeconomicunions,andbyinternationalorgans.

LastNovember,IaddressedmembersoftheUNSecurityCouncil.Idrewtheirattentiontothethreatposedbyemergingandepidemic-pronediseases,andreassuredthem.

WHOusesasophisticatedelectronicsurveillancesystemtogatherdiseaseintelligenceinrealtime.Wearerarelytakenbysurprise.

WHOcanmountaninternationalresponsewithin24hours.ThisisbecauseofyoursupportthroughtheGlobalOutbreakAlertandResponseNetwork,butalsothecapacityofourcountryofficestogetvisas,movesuppliesthroughcustoms,andcoordinateeverystepofthewaywiththeMinistryofHealth.

Nootheragencycandothis.

YouhavebeforeyouareportonprogressinbuildingthecorecapacitiesneededtoimplementtheInternationalHealthRegulations.IlooktoyouforfurtherguidanceandadviceasweworktoseetheIHRfullyimplemented.

WeseeWHOleadershipatwork,oftenbringingoutsizedresultsforsmallbutsmartinvestments.

Africa’snewmeningitisvaccine,developedinaprojectcoordinatedbyWHOandPATH,isbeingrolledout,promisingtoendseasonalepidemicsinAfrica’smeningitisbelt.Thepaybackwillbeenormous.Asinglecaseofmeningitiscancostahouseholdtheequivalentofthreetofourmonthsofincome.Mountinganemergencyimmunizationcampaigntocontrolanepidemiccanabsorbasmuchas5%ofacountry’sentirehealthbudget.

WHOleadershipbroughttheneglectedtropicaldiseasesfromobscurityintothelimelight.TheseCinderelladiseases,longignoredandunderappreciated,arearags-to-richesstory.

InJanuary,apharmaceuticalcompanypledgedtostepupitscontributionofpreventivetreatmentsforschistosomiasis10-fold,reaching100milliontreatmentsperyearby2016.

WHOadministersthedistributionofthemajorityofdrugsdonatedtocontroltheneglectedtropicaldiseases.WiththeJanuarycommitment,WHOisnowinapositiontoprotectallschool-agechildreninAfricaatriskofschistosomiasis.

Wecanblanketthispartoftheworldwithmedicinesthatrideveryschoolchildofwormsandeggs,parasitesthatinterferewiththeirlearning,impaircognitivedevelopment,andcompromisetheirnutritionalstatus.

Thisisagifttotheirhealth,butalsototheeducationandnutritionsectors.

Lastyear,WHOrecommendedabanoninaccurateandcostlycommercialbloodtestsfordiagnosingactivetuberculosis.Lastweek,thecountrywiththelargestuseofthesetests,especiallybyprivatepractitioners,announcedlegislationbanningthetestsnationwide.

Morethanamillionofthesemisleadingbloodtestsarecarriedouteachyear,oftenatgreatdangerandgreatcosttopatients,whomayhavetopayupto$30pertest.

Thinkofwhatwearesaving.

Followingpublicationofthe2010WorldHealthReportonhealthsystemfinancing,morethan60countrieshaveapproachedWHOseekingtechnicalsupportfortheirplanstomovetowardsuniversalcoverage.

Whatweareseeinggoesagainstthehistoricalpattern,wheresocialservicesshrinkwhenmoneygetstight.Ithinkthisdrivetoexpandcoverageisapowerfulsignal.Despite