‘The greatest wealth is health’ – Commonwealth health challenges for the 21st Century
Date: 13 May 2007
Speaker: Secretary-General Don McKinnon
Location: Commonwealth Health Ministers Meeting, Geneva, Switzerland
Your Excellencies, Ladies and Gentlemen – welcome to Geneva and to the Commonwealth Health Ministers Meeting. We hold it, as ever, on the eve of the World Health Assembly.
I thank my Commonwealth Secretariat colleagues for all that they have done to bring us here; and I thank you all – speakers and listeners alike – for coming. We are particularly honoured to be addressed today by two very important people from the WHO: its new Director-General Dr Margaret Chan, whom I had the pleasure of meeting last month; and Dr Shanti Mendis, our keynote speaker today.
‘The Wealth of Nations’; ’the Health of Nations’. ‘The greatest wealth is health’, wrote Virgil. The two are interchangeable, like our two Commonwealth cornerstones of Democracy and Development.
Does that mean that developed countries enjoy perfect health? Of course not. One of our themes today is that developed countries face ever greater challenges in the face of the so-called ‘lifestyle diseases’ of the heart, the lungs, the pituitary. But an even bigger theme is that developing countries face the challenge of lifestyle diseases, too – on top of so many other challenges presented by the so-called ‘communicable diseases’.
Which is why, in my time with you now, I would like to dwell on the health of the less wealthy nations of the Commonwealth.
The Commonwealth of 53 countries across 6 continents; of 1.8 billion people of every colour, race and creed.
The Commonwealth that is home to a third of the world’s population – yet two-thirds of its AIDS sufferers, two-thirds of its maternal deaths, two-thirds of its children under 5 suffering from malnutrition, nearly half of its infant deaths.
The Commonwealth that estimates that it needs at least another 2 million health workers if it is to have the slightest chance of meeting the three Millennium Development Goals which deal with health.
Let me tell you two very obvious things about those Goals.
MDGs 4 and 5, reducing infant and maternal mortality by two-thirds by 2015, are the most off-track of them all, above all in Sub-Saharan Africa and South Asia.
Meanwhile MDG 6, reversing the curses of AIDS, malaria and other diseases by 2015, barely has an end in sight, above all when you consider that there were 2.6 million more people living with HIV/AIDS in 2005 than 2004, and 400,000 more new infections.
Perhaps I tell you nothing new with these horrible statistics, but I tell you nonetheless. That is part – a very large part – of the context in which we meet.
Another part of my own, personal, context in being here today is the fact that this time next year, you will have a new Commonwealth Secretary-General. I don’t wish to cheapen our Commonwealth challenges by using too strong language: yet some of the very greatest of our challenges are in health – how can they not be after the facts I have just given you? So today I’d like to ask how we have done these last 8 years ‘on my patch’, and how we can do better.
Nearly 20 years ago, I was for 3 years the Shadow Health Minister in New Zealand. So I know all of the pressures that you Health Ministers are under. I know all of the tensions you experience between what is potentially available and what is actually available. Indeed, I know that you are never going to be able to do everything that you want to do. Whether you spend 6.9% of GDP on health as they do in Commonwealth Canada or the UK, or 0.6% as they do in Commonwealth Pakistan, it’s never enough. And even if we make exponential leaps in what we can do; we can’t conceive of making that skill or medicine available to 95% of the people in the world who need it most.
I also know that this health train keeps running: no one can get off. Since we last met 12 months ago, we estimate that the SARS epidemic cost the world $60 billion. The potential devastation of Avian flu has fueled further fears. It, and infectious agents such as drug resistant tuberculosis, show us that the many benefits of globalization come with risks: porous borders, increased air travel and increasing migration levels all have implications for the health of our citizens.
But the most important context of our Meeting today is that we have the power – in this room and in this Commonwealth – to do something about these health challenges. We have the power to meet them head on.
Because the story of ‘the Health of Nations’ is not just one of bad news.
Life expectancy in the developing world has grown from 46 to 63 in the last 40 years. Smallpox has disappeared. Infant mortality rates have slowly come down. Measles is no longer a mass killer; river blindness and guinea worm are becoming footnotes of history.
What has been the secret of some of these successes?
In part, the tools. We are developing new vaccines, like the one for Hepatitis B; new medicines, like Malarone; and even new and simple remedies, like insecticide-treated bed-nets. After 40 years, we are once again using DDT against malaria.
In part, the organisation: whether it’s through the WHO… or GAVI… or the Roll Back Malaria Partnership… or the Stop TB Campaign. We are primed for action.
In part, the political will. In the Commonwealth we can be proud of the role that our richer governments have played both in funding these global initiatives, and in putting the pressure on to ensure that they deliver. I particularly applaud the UK with its support for GAVI.
In part, the realization that health is vital to development. Remember that ground-breaking World Bank Development Report of 1993 that so powerfully made this case.
And in part, the new coalitions and the new players entering the health arena – whether it is governments, big companies, the professional bodies, local NGOs or international philanthropic trusts like the Bill and Melinda Gates Foundation …. never have we had more goodwill and expertise at our disposal. And indeed never have we so needed to use the skills of different groups of people – including community groups, labour unions, faith-based organisations, the media and academia – who can be at the heart of our education about health.
That is why I paint a picture of hope. The global successes have been reflected in the Commonwealth successes. Indeed, they have been reflected in this very Commonwealth Health Ministers Meeting. You should be proud of your achievements in this forum.
I often cite the fact that it was in 1998, at CHMM, that you Health Ministers first brought global attention to the impact on health systems caused by the loss of health workers. At CHMM in 2001, you called for a Commonwealth Code of Practice to unite our best efforts, and at CHMM in 2003 you adopted that same Code.
The Code protects the most vulnerable states, while also protecting the rights of the migrating health workers themselves.
It, in turn, has led to a number of bilateral agreements between Commonwealth countries, for instance between Kenya and Namibia. It has been the model for regional codes, like that recently adopted by the states of the Pacific. It has allowed us to open a dialogue with the largest single importer of health workers, the USA.
Meanwhile Mary Robinson is chairing an international task force on health worker migration. I’m proud to report that the Commonwealth has been asked to sit on that committee, and I believe that our Commonwealth code can be the basis of a new global code.
That is just one of our Commonwealth health successes. It demonstrates how the standards and principles concerning sensitive issues brokered in this, the safe political space of the Commonwealth, can then feed in to the global agenda.
Ladies and gentlemen, I thank you for your efforts to make these things happen.
So, too, do I thank you for combined Commonwealth efforts in other areas….
Take polio – which has been eradicated in 50 of our 53 countries. I believe that a polio-free Commonwealth is within sight. With our renewed strategies and concerted efforts, the Commonwealth should soon be free of polio. I hope to meet with Ministers of the three remaining polio countries at lunch, to discuss what still needs to be done, and how the Secretariat can assist.
Take AIDS – in which 28% of Commonwealth citizens needing anti-retroviral therapy are now receiving it: that figure was 2% five years ago. This is progress – but it’s nothing like good enough. We cannot relax until all the Commonwealth citizens who need it are receiving the lifesaving treatment they need. Commonwealth advisers have in the last 12 months looked closely at nine national AIDS strategies across Africa, Asia, the Caribbean and the Pacific. The bad news is that they found serious deficiencies in all. The good news is that they then helped many countries to put in place effective policies, as well as national structures like HIV/AIDS commissions.
And finally take maternal health – where we have assisted our member countries to initiate the audits which are a prerequisite to reducing high maternal mortality rates in the Commonwealth. And we have contributed towards the training of professionals working in maternal health, too. Just a month ago, I was lucky enough to witness final preparations for a Commonwealth training course for midwives in New Delhi. It is the power of building skills and understanding, in what are – of course – matters of life and death.
All three of those tasks – polio, AIDS and maternal health – need more of our efforts. All need a renewal of those magic ingredients with which I began: the tools; the organization; the political support; the new coalitions and the new players; and a sense of health as an element of development.
All three require more money. That means those renewed commitments to lift the amount of aid money from the wealthy, developed world must be delivered. The Scandinavians are already there …. but some of those who’ve made the commitments are far from reaching the target. Meanwhile all have made promises to make their contributions to the Global Fund for AIDS, TB and Malaria and its stated need for US$ 9.7 billion by 2008. Yet only US$ 6.7 billion has so far been received. In April 2001, 54 African governments pledged to allocate at least 15% of their national budgets to the health sector. They haven’t done so.
My 8-minute sketch on the health challenges of my 8 years as Commonwealth Secretary-General ends here.
So my ‘prescription form’ for the next 8 years reads very simply: ‘continue treating the causes, before even the symptoms, of ill health; expand the supply of trained health workers; and build strong health systems with long-term predictable financing’. Those three things.
I add a postscript, placing health in its proper social and economic context, under four headings.
First, women and girls – whose social status has to be raised to stop them, quite literally, dying of discrimination.
Second, poverty – which continues to kill and stunt our people, and whose root causes we must address.
Third, conflict – which kills and disables and destroys both our physical and our mental well-being, and which must be resolved.
Fourth, social exclusion – whether of people living with AIDS or living in remote rural areas, and which has to be overcome if health services are to reach the people who need it most.
I am making the simple point that health is an element of democracy and development.
Which brings us to lifestyle diseases, our specific topic today.
It was my mother who taught me the nursery rhyme which, you could say, gives the answers to all our lifestyle disease issues:
The best six doctors anywhere
And no one can deny it
Are sunshine, water, rest and air,
Exercise and diet.
But that is to overlook some rather important facts. Heart disease, cancer, diabetes and chronic pulmonary diseases have become a real burden on the health systems of developed countries. For a while, these diseases were associated with economic development. In fact, they were called ‘diseases of the rich’. The result? The global burden of these non-communicable diseases in poor countries and poor populations has been seriously neglected by policy makers, major multilateral and bilateral donors, as well as academics.
That, colleagues, is the deficiency we must begin to plug today. Because by 2020, it’s estimated that non-communicable diseases will cause 7 out of every 10 deaths in developing countries. Even now, there are 30 million deaths a year from these largely preventable conditions, largely in developing countries.
Today, I hope we will look at the social, economic and environmental trends which are driving this crisis in lifestyle diseases – in richer and poorer countries alike.
I hope we will look at those ‘best six doctors anywhere’, and how to make them a reality. Let’s talk in particular about the use of tobacco, which causes more deaths each year than HIV, drug and alcohol abuse, motor accidents, suicides and murder combined.
And I hope we will look at everything we have prescribed before: the tools; the organization; the political support; the new coalitions and the new players.
Ladies and gentlemen, health is a development issue and development is a health issue. I come back to Virgil: ‘the greatest wealth is health’. Until all of our citizens have access to the level of healthcare that is their human right, none of our efforts towards democracy and development will succeed. The virtuous circle continues: democracy and development in turn provide the environment for good health.
I wish you every success in your meeting today, and in all your ongoing works to promote good health in the Commonwealth.
Thank you.
ENDS
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‘The greatest wealth is health’ – Commonwealth health challenges for the 21st Century
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