Dr Margaret Chan
Director-General of the World Health Organization
Keynote address to the Regional Committee for the Western Pacific, Sixty-fourth session
21 October 2013
Mr Chairman, Excellencies, honourable ministers, distinguished delegates, Dr Shin, ladies and gentlemen,
It is a great pleasure to address countries of the Western Pacific Region, to celebrate your many successes, and to learn how you plan to tackle new problems and accelerate progress on older ones.
This is a region of advanced economies and struggling economies, of the world’s most populous country, and its smallest island nation. Despite this diversity, countries of the region are united by their shared and steady improvements in health.
You really do help each other, and hold together in matters of health. You and your Regional Director can be proud of a number of achievements. This has always been my home region, so I share your pride.
The Western Pacific Region remains polio-free. The 2011 outbreak in China was swiftly and successfully contained. This potential setback reminds us that no country or region will be safe until the virus is entirely eradicated from the world.
The HIV epidemic has stabilized and begun to decline. Nearly half of people eligible for antiretroviral therapy are receiving it, representing a 16% increase in coverage within a single year. Programmes are being adapted in line with the recommended use of antiretroviral therapy for prevention as well as treatment.
The region is on track to meet the Millennium Development Goal for tuberculosis. Malaria cases and deaths are going down. For both of these diseases, antimicrobial resistance is a worrisome problem that needs to be closely monitored. Prospects for eliminating lymphatic filariasis look good.
Most countries have seen major reductions in the number of maternal and child deaths. In some countries, the decline has been remarkable, thanks to innovations that can serve as models in other parts of the world.
You will be looking at a draft action plan for healthy newborn infants. This is the first such plan in any WHO region. It illustrates a trend I wholeheartedly support. That is, use very simple, cost-effective interventions to save lives.
It draws attention to a number of common but inappropriate and unnecessary practices, and aims to correct them. It introduces the importance of the First Embrace and shows how simply changing the sequence of steps in newborn care can save lives.
As this region is well aware, health systems need to do a much better job of counting births and deaths. Violations of the International Code for the Marketing of Breastmilk Substitutes are rampant, and this needs to change.
The International Health Regulations are working. This was readily apparent earlier this year when the new H7N9 virus emerged in China.
Ten years ago, few would have expected to see research from Chinese clinicians, virologists, and epidemiologists dominating the pages of the New England Journal of Medicine. Every country in the world can be grateful to China for its vigilance, rapid action, immediate sharing of viruses, and constant flow of information.
In this Decade of Vaccines, your countries are demonstrating the preventive power of childhood immunization on a grand scale. The number of measles cases has seen a 93% reduction over the past four years. The region as a whole is on the verge of interrupting transmission. You are ready to do so, with a verification commission in place.
Historically, this region has had some of the highest rates of liver disease in the world. Today, you have the highest rate of coverage with hepatitis B vaccine, anywhere in the world.
The fact that 96% of the region’s children have been protected with three doses of vaccine is a stunning achievement. So are the gains, which are expected to prevent around 10 million chronic infections and 2.5 million future hepatitis B-related deaths.
You have established a panel of experts to provide independent verification of country progress. This brings confidence and honours transparency.
You will be considering even more ambitious goals for hepatitis B protection. Aiming high in the context of integrated service delivery draws other improvements along the way.
To reach more infants within 24 hours after birth requires more mothers delivering babies in health facilities and greater coverage with skilled birth attendants. This improvement, in turn, will help reduce maternal and neonatal deaths, especially since most infant deaths in the region occur within the first three days of life.
In China and Viet Nam, the drive to extend hepatitis B protection has been linked to efforts to eliminate mother-to-child transmission of HIV and congenital syphilis.
All of these achievements free up resources and hospital beds for responding to the next wave of challenges, including those that have made this region the epicentre for chronic noncommunicable diseases.
Ladies and gentlemen,
The two biggest items on your agenda, noncommunicable diseases and ageing populations, are, to an extent, the price paid for the region’s rapid economic growth and modernization. Nothing illustrates this better than the NCD situation in the Pacific islands and diabetes in China.
Just 50 years ago, NCDs were not a priority in the Pacific islands. Diets were rich in fruits and vegetables. Fish was the principal source of protein. People drank water.
Over a remarkably short time, diets shifted to white bread, white rice, white sugar, sugary beverages, and highly processed foods, including canned luncheon meats. Today, the Pacific island countries and areas have the highest rates of obesity in the world, as high as 75% in some areas.
Elsewhere in the region, changing lifestyles and increased purchasing power have led to more women in the workforce, a reduction in breastfeeding, fewer meals eaten in homes, and an increased consumption of junk food, alcohol, and above all tobacco. This is a region with 430 million smokers
Your regional action plan rightly stresses the need for prevention and is appropriately alert to the dangers of marketing unhealthy foods and beverages to children.
WHO will never be on speaking terms with the tobacco industry. I have nothing against collaboration with the food, beverage, and alcohol industries, but with two strong qualifications.
First, these industries must not touch or influence in any way the formulation of standards and policies aimed at protecting the health of the public. Second, their behaviour must be closely and critically monitored. They make a lot of promises, but do they keep them?
The one thing these corporations fear most is the regulation, for valid health reasons, of their products. Countries that choose this route must expect resistance, well-financed and orchestrated resistance.
Look at what Australia has gone through with its legislation mandating the plain packaging of tobacco products. Look at the army of lobbyists employed to derail the European Union’s Tobacco Directive earlier this month.
Your action plan includes a timely warning: “Trade agreements should not hamper public health efforts to protect people from NCDs.” Be sure that health has a place at the table when ministers of trade and finance negotiate trade agreements.
My dear ministers of health, if you are not at the table, you are on the menu.
Too often, all eyes are completely focused on short-term economic wins, and closed to the costs and consequences of NCDs. When this happens, economies can move in a direction where the burden of these diseases cancels out the benefits of economic gain.
Last month, Chinese researchers published the results of a large study on diabetes prevalence and access to care in that country. The authors estimated that China now has 114 million adults living with diabetes, representing a prevalence in the adult Chinese population of nearly 12%. Less than a third of those surveyed were aware of their condition and only a quarter reported receiving treatment.
In perhaps its most shocking finding, the study estimated that nearly half of the entire adult Chinese population has pre-diabetes, amounting to an additional 493 million people at risk of this debilitating disease, with all its costly complications. Think about what this means in the world’s second largest economy.
I fully support your draft strategy on ageing and health. Age-friendly primary care must be the entry point for a continuum of care that goes from prevention and self-care in the community, to outpatient care, to the hospital and specialist care, to step-down care for people who no longer need a hospital bed but are not yet ready to return to their homes.
People over the age of 60 years are becoming the world’s new majority. They are ageing with an attitude.
They will increasingly insist on having a say in decisions that affect their health. In doing so, they can take support, and bargaining power, from associations of older people. They can use their numbers to exert political influence, to the benefit of public health.
Ladies and gentlemen,
I have a final comment. This region was ahead of the curve in 2008, when you established universal health coverage as the goal that should guide the strengthening of health systems.
Prospects are good that UHC will find a place on the post-2015 development agenda. The current enthusiasm for UHC has breathed new life into the vision of primary health care, where WHO and its Regional Offices have solid experience to offer.
Among your outstanding achievements, I need to include the major review of the region’s six health systems strategies that will be discussed during this session. This is the kind of analysis I deeply appreciate, especially at a time when WHO is undergoing reform.
WHO needs to know if its technical guidelines and advice are actually having an impact on policies and health outcomes in countries. The analysis extracts a number of practical lessons.
For example, the six strategies taken together ask countries to monitor 122 indicators. This is asking way too much, and needs to be simplified.
The analysis underscores a number of weaknesses, including inadequate systems for civil registration and vital statistics, and a continuing irrational use of medicines that is contributing to the rise of antimicrobial resistance.
On the positive side, the analysis clearly shows that WHO’s technical guidance is highly valued in the formulation of policies, but also in helping convince governments to commit funding for health system development.
But this is the finding I like best. What countries value most is the hands-on expertise of staff in the regional and country offices. That’s what makes the most difference. This is WHO at its best.