WHO Director General praises Europe for leadership and warns against complacency in fragile times

14 September 2010

The second day of the 60th annual meeting of the European Regional Committee (RC) of the World Health Organization was opened with an inspirational address from WHO Director General Dr. Margaret Chan. The Director General (DG) spoke of phenomenal progress that has been made thanks to unwavering commitments from Member States to improve the health of their populations and of populations the world over. But "this is a time of reckoning, and it is a fragile time" warned Chan, "public health must be smart, strategic, and resourceful as never before"


A fragile period when new progress can be lost or furthered

As we approach the 2010 UN High-Level Meeting on the MDGs next week there is plenty of good news to celebrate. "Investment in health development is working" said Chan, "the number of under-five deaths dipped below 10 million for the first time in nearly six decades, and then dropped again to under 9 million. Later this week, UNICEF and WHO will issue new estimates showing another decline of nearly 1 million deaths."

We can also celebrate major victories in the fight against HIV/AIDS, tuberculosis and malaria. The number of people in low- and middle- income countries on retroviral therapy has risen from under 220,000 in late 2002 to well over 5 million today. Rates of new tuberculosis infections have peaked and started a slow but steady decline and for the first time in decades, data from sub-Sahara Africa suggests that malaria maybe in retreat - some countries have seen malaria deaths decline by 50% thanks to a high level of coverage of the necessary interventions. Chan also shared with delegates that tomorrow the WHO will release jointly with UNFPA, UNICEF, and the World Bank, new estimates indicating a significant worldwide drop in maternal mortality, with the greatest declines of around 60% reported in East Asia and Northern Africa.

"Progress in all these areas is significant and very welcome, but progress is also fragile, for reasons largely beyond our control" emphasized Chan. The financial crisis and global economic downturn continues to have a lasting impact on population health and health spending. In times of austerity, Chan argued, we must take extra steps to safeguard against losing ground. For example efforts to roll out vaccines to prevent pneumonia and diarrhoeal disease, the two biggest killers of children in developing countries, are being threatened by a shortfall in funds. "What will it mean" questioned Chan, "if a financial crisis, seeded by greed, cancels out fragile health gains made possible by so much good will and innovation? Does the worst in human nature win over the best? These are big-picture issues, and they need to be raised."


A time of consequence, a time for change

"The bills for past extravagance are falling due" declared Chan, "Climate change is the price being paid for policies that favoured the growth of economic wealth over the protection of ecological health". The increasing occurrences and devastation of downpours, mudslides, floods, heat waves, drought, wildfires and ruined crops fits the models that climate scientists have warned of. While the local populations suffer immensely, the stress is also felt internationally. Crop losses in Russia and Pakistan are already being reflected in global grain prices. "We have to anticipate another global crisis of soaring food prices that will hit poor households the hardest" said Chan.

"The first decade of the 21st century" said Chan, " may very well go down in history as the time when nations came face to face with the perils of interacting in a world of radically increased interdependence." The need for a coherent global health policy becomes all the more important given the diverse and complex health challenges facing public health. "More and more, health is the unwitting victim of policies made in the international system that tie countries, economies, commerce, trade, and foreign affairs together" explained Chan, and "these days, politics must be the bedside manner of health officials if they want to get results."

Chan referenced a single set of policies, for food, and a single disease, diabetes, as an excellent example to clarify what is meant by the new complex multisectoral interdependencies. The industrailzation of food production has made it possible to feed the world's growing population. But this trend, combined with the globalization of food marketing and distribution, has brought processed foods, rich in fat, sugar and salt, yet low in essential nutrients, into every corner of the world, including cities throughout the developing world-and these are the foods that contribute to obesity and chronic diseases. Type 2 diabetes, which is linked to unhealthy diets, has reached epidemic proportions in Asia. People in this part of the world are developing diabetes in greater numbers and at a younger age than diabetics in industrialized countries, and they are dying sooner. "Some economists have described this rising prevalence of obesity and diabetes as a ‘side-effect of progress'" said Chan, "but I would raise the question, is this progress at all? What is the net gain when economic development sets heath development backwards?"


The need for clear and effective leadership and communication

Just as new gains in global health are fragile in these turbulent times, older accomplishments and goals are also in danger of lapse. The outbreak of polio in Tajikistan threatens the whole European region's polio-free status and the goal of eradicating measles and rubella, and preventing congenital rubella syndrome by 2010 will not be met. "Though perfectly feasible from a technical perspective," explained Chan, " prospects for elimination have been dampened by political and public complacency, including unfounded concerns among parents about the safety of vaccines." As was also emphasized in the speech by Regional Director Jakab yesterday, Chan emphasized that "some traditional solutions and traditional ways of working, no longer match the complex realities of today's public health landscape."

For example, the time when the public health community can issue advice based on scientific evidence and expect the public to comply has come to an end. Citizens make their own conclusions based on the information that they gather themselves from sources that may or may not be valid. Meanwhile citizens and governments are growing numb to issues that have exhausted public attention, like HIV/AIDS and natural disasters such as the floodings in Pakistan. The challenges today are more complex, but so are the competing interests and influences on public opinion and political action. Strong and scientifically sound leadership that can communicate in today's fast paced social media is needed to prevent the spread of misinformation and the ill-informed actions whose consequences on health maybe indirect and difficult for the public and politicians to understand.


The leadership of the European Region and the WHO

DG Chan referred the European region as "the bellwether for health trends and challenges that eventually affect the rest of the world," and as a result, the Region has "pioneered policies and approaches that serve public health everywhere." DG Chan commended the delegates for making strengthening European contributions to global health, also through foreign policy, one of the region's top priorities.
"European countries are leading the quest for a coherent global health policy," acknowledged Chan, "the public health community counts European countries among its most generous, and frankly, most innovative and forward-looking donors." DG Chan concluded that this leadership was particularly evident at last June's high-level meeting in Brussels on the EU Role in Global Health.

WHO must also continue to show strong leadership, which is why DG Chan welcomes the scrutiny that the organization has come under for its performance during the H1N1 influenza pandemic. The DG acknowledges that improvements must be made, but also that there has already been much improvements when compared to earlier crisis, such as SARS, which she was deeply involved in managing. The DG puts her trust in the outcome of the H1N1 review committee which will meet again later this month, to give guidance for further improvements, but she did not shy away from addressing one particular question with clarity: "I can assure you," underscored Chan, "never for one moment did I see a single thread of evidence that pharmaceutical interests, as opposed to public health concerns, influenced any decisions or advice provided to WHO by the experts."

The DG's address covered a broad range of issues and sweeping challenges. We have achieved so much progress through working together, it would be a tragedy to lose focus now. A small slip in political will could be devastating at this time, while redoubling our efforts could also achieve significant results. Her address not only confirmed the important role that the WHO plays within the European Region, but the crucial role that Europe plays in the world as an influential and strong leader for health at the global level.



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