SPEAKING TO NEW YORK ACADEMY OF MEDICINE, SECRETARY-GENERAL SAYS

PUBLIC HEALTH CHALLENGES ARE ALSO DEVELOPMENT, SECURITY ISSUES

Following is the text of the statement by UN Secretary-General Kofi Annan on 9 May, to the 159^th Annual Stated Meeting of the Fellows of the New York Academy of Medicine, entitled “Global Health: Challenges, Capacity and Responsibility”:

It is a privilege and a pleasure to be here.  As your institution holds its 159th annual spring meeting, the United Nations has only just celebrated its sixtieth anniversary.  Clearly, my Organization has a long way to go to catch up with yours.

In fact, being thrust into the midst of the Fellows of the New York Academy of Medicine is humbling to me in many ways.  Analyzing the sort of political problems I deal with does require some diagnostic ability.  But I have no skill whatsoever with a microscope, and my knowledge of anatomy is quite limited, so my credentials for this gathering are fairly modest.

In my business, preventive measures are what we apply to try to avert an armed conflict, and operations have more to do with peacekeeping troops and blue helmets than with scalpels and anaesthetic.  If Hippocrates were mentioned in the UN General Assembly, many of the ambassadors would probably assume that they were being accused, once again, of hypocrisy.  Indeed, some might say that we could do much more to comply with the first principle of Hippocrates: “first, do no harm”.

Still, we in the United Nations family do know that human health is crucial to our mission for development and security around the world.

That is something I have been deeply conscious of, ever since I first started my career in the United Nations family.  Some of you may not know it, but my first job was actually in the World Health Organization -- back in the mists of time, not long after the discovery of the four humours; around the time the birth control pill was being introduced; years before the eradication of smallpox; and a full two decades before the word AIDS first entered our vocabulary.

The Fellows of the New York Academy of Medicine have witnessed, at first hand, that march of time and its impact on the health of humankind.  Since your institution was created, life expectancy in this country has literally doubled, largely thanks to the conquest of infectious diseases.  That progress continues today.  But, if some of the advances have defied what we could have imagined just a few decades ago, so too have some of the challenges.

You have seen vivid evidence of that through your mission to improve the health of people -- particularly disadvantaged people living in cities.

Your focus on urban health is also a valuable vantage point from which to understand the challenges of health worldwide.  The issues you confront -- from health disparities to HIV/AIDS and access to care -- are the same that we face, writ large, on a global scale.

Today, more than half of humankind lives in cities.  That is more than 3 billion people.  Nearly 1 billion, one in every six human beings, is an urban slum dweller living without adequate shelter and basic services.  This figure is expected to rise to 2 billion over the next 25 years.  As poverty grows increasingly urban, the greatest impact will be felt in the very poorest countries.

Urban poverty, in turn, creates an entry point for disease and ill health.  Millions of people are homeless.  The most vulnerable, including women and children, are the first victims of violence, crime, overcrowding, and all the health hazards associated with inhuman living conditions in rapidly growing cities.

It is in these urban killing fields that epidemics take their heaviest toll.  That applies to all the biggest killers of our time -- malaria, tuberculosis [TB] and HIV/AIDS.

Let us take a look at that triad of diseases and the effects of each, in turn.

There are at least 300 million acute cases of malaria each year -- leading to more than a million deaths annually.  Nine out of ten of these deaths are in Africa -- mostly in young children.  Malaria is Africa’s leading cause of under-five mortality.  It accounts for 40 per cent of the continent’s already overburdened public health expenditure.

Five thousand people die from tuberculosis every day.  TB kills more than a million and a half every year, and more than 8 million new cases are detected annually.   Africa is the only continent where the number of cases continues to increase.  Last year, African health ministers declared TB an emergency.

We cannot win against TB without progress against the disease that leaves so many defenceless against it -- HIV/AIDS.  The AIDS pandemic killed nearly 3 million people last year.  It is taking a rising, alarming and disproportionate toll among women and young people.  It continues to wreak a path of destruction, again, most severely in Africa -- but it is probably the most globalized and destructive epidemic ever.  Because it primarily kills adults, AIDS is driving poverty, orphaning millions of children and causing a steady erosion of public services -- from police and the armed forces to education and local government, and, of course public health.  In this way, it is not only an unprecedented obstacle to development; it also poses a threat to stability and security.  This is why, for several years now, I have made the battle against AIDS my personal priority.

Ladies and gentlemen, experiences in the past few years have forced Governments everywhere to accept that the health challenges facing us are global, and do not respect boundaries.  No country is immune.

SARS infected over 8,000 people in 30 countries in the course of three months during 2003, and managed to compromise both rudimentary and advanced health systems in developing and developed countries alike.

In the past year, avian flu has forced the slaughter of millions of animals across three continents, as experts warn that the virus could mutate and prompt a human influenza pandemic.  The flu pandemic which began in 1918 killed up to 50 million people -- and that was before the age of air travel.

The same or more dramatic consequences could result from an accidental or deliberate release of lethal biological agents.  Those risks are bound to grow as advances in biotechnology continue to outstrip our capacity to establish necessary safeguards and regulations.

All those threats to our biological security, disparate as they may seem, are interconnected.  We have no choice but to address them all.  We must move away from the kind of health interventions that I would liken to peacekeeping without peacebuilding:  humane and essential, but all too often lacking the necessary longer-term effort to consolidate results and make them sustainable.

That will require acting on a number of priorities:

First, we must dispel the notion that public health challenges are simply public health issues.  Major challenges, such as AIDS, child survival and the threat of a flu pandemic, are also development issues and, sometimes, security issues.  So our response must engage the highest levels of Government, civil society, business and finance.  We must abandon traditional bureaucratic thinking, and work across ministries and departments to forge a holistic approach.

For such an approach, look at the AIDS crisis.  After a tragically late start, there has been a response at the level required, including sessions in the UN Security Council, the UN General Assembly, the World Trade Organization, the African Union and the Group of Eight.  There are now many Heads of State or Government who personally lead their countries’ response to AIDS.  Only in this way does the world finally stand a chance of turning the tide on this pandemic.

Second, we must devote greater resources to disease surveillance and response.  Last year, the World Health Assembly adopted new International Health Regulations -- a bold and necessary step to improve global efforts to contain outbreaks.  Governments must devote greater attention and resources to building local and national capacities for early detection and response.  Donors -- if only out of self-interest -- must work with developing countries and assist them.

Third, we must act on the understanding that public health hinges not only on medical technologies and interventions.  It depends just as much on factors such as the empowerment of women, human rights, education, a healthy environment and decent work.  It is this understanding that forms the basis for the Millennium Development Goals -- the set of objectives agreed by all the world’s Governments as a blueprint for building a better world in the twenty-first century.

Fourth, and critically important, we must make new and serious efforts to build health systems that afford universal access in developing countries.  At the core of this challenge lies the need to address the acute shortage of health workers in so many developing countries.

In the past few years, it has become clear that health systems are nowhere near equipped to deal with the growing challenges facing them.  In many parts of the world, the health workforce is in acute crisis.  The global population is growing, but the number of health workers in many of the poorest countries is falling.

Across the developing world, health workers face economic hardship, deteriorating health infrastructures and social unrest.  The issues are complex, including working conditions and pay, lack of adequate training, and the exodus of highly trained and skilled health professionals to richer countries.  AIDS has hit health workers particularly hard, taking their own health and lives, as well as those of their patients.

Africa alone will require 1 million new health workers to meet the minimum needed to achieve the Millennium Development Goals.  Without such a dramatic increase in capacity, paediatric immunizations will not be administered; infectious outbreaks will not be contained; curable diseases will remain untreated; and women will keep dying needlessly in childbirth.  And we certainly will not be able to make the inroads we need against AIDS, TB and malaria.

Addressing this capacity crisis demands partnership and cooperation nationally and globally, across all sectors -- including education, transport and finance -- as well as within the health workforce itself.

It requires us to build coalitions around national emergency plans for health, combining technical know-how, innovative strategies and political support -- nationally and internationally.

It requires us to deal with workforce constraints more directly.  That means exploring new human resource policies to retain health workers, to make sure we address their concerns throughout their working lives.

And it requires substantial financial commitments to train and pay new workers.

We need to build on the wealth of talent that exists in developing countries, so as to construct a workforce capable of taking on people’s every day needs, as well as the big killers of our age.  That means a transformation on the same scale as what took place in this country in the early part of the last century -- a transformation, which took the US health system from an assortment of lay practitioners, to a cadre schooled in scientific medicine.

Today, some rich countries import up to 25 per cent of doctors and nurses from overseas, particularly from developing countries -- providing opportunities for individuals, but also weakening capacity in their land of origin.  Yet, at the same time, many developed countries are beginning to recognize our interdependence in human health.  They can act on that understanding, by dramatically stepping up their investment in human resource development overseas, for the benefit of all countries.

They can increase support for the Global Fund to Fight AIDS, Tuberculosis and Malaria, which, in a few short years since it was founded, has become a leading financier of programmes to fight these three pandemics.

They can strengthen their backing for the work of UNAIDS, the programme bringing together the efforts and resources of 10 different parts of the UN family in the fight against the AIDS pandemic.

They can invest in the World Health Organization’s Global Malaria Programme, as well as in national strategies against malaria.

They can help implement the recommendations of the Global Plan to Stop TB, launched by WHO just this year.  If the Plan is fully carried out, we can save 14 million lives in the next 10 years -- but only if everybody plays their part.

And they can help meet our collective responsibility to ensure that all countries -- rich and poor -- are protected and prepared in the event of a human flu pandemic.

This country is a crucial partner and generous supporter in all those areas.  We cannot win the war for global health, without the contribution of the United States.  Organizations like yours have a key role to play in building the awareness and vigilance needed to sustain that contribution.

I am grateful to all of you for listening to me today.  Above all, I am heartened by your commitment to human health around the world, and I hope that many more will follow your example.

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For information media • not an official record