Equal Opportunities to «Health For All», Pascoal MOCUMBI’s Vision for WHO

Addressing Priority Health Problems

Principal Health Challenges

The world still faces enormous health challenges. Many affect all countries — HIV/AIDS, TB, mental health problems, intentional and unintentional injuries and the increasing burden of chronic and non-communicable diseases. To take one example, HIV/AIDS has changed the pattern of life in many countries, with serious implications for developmental strategies. It is of paramount urgency to tackle this universal scourge. We need to ensure that the agreed commitments from the special session of UN General Assembly on HIV/AIDS are met. Much has been achieved within the UNAIDS framework, particularly in advocacy and building awareness regarding the gravity of the situation. WHO will continue to work with UNAIDS to ensure effective advocacy for adequate investment of global resources to tackle HIV/AIDS. Together, we must guarantee that proper support is provided to countries to design and implement their action programs on HIV/AIDS.

Other diseases are less geographically widespread, but no less serious. Malaria, Schistosomiasis, intestinal parasitosis, Leprosy, Dengue, Chagas ’ disease and many communicable diseases still continue to constitute major health problems to considerable sectors of humanity, particularly in low-income countries, as do high maternal and peri-natal mortality. The underlying cause of these diseases is poverty further compounded by lack of access to promotional and preventive health measures, pharmaceuticals and appropriate health care. I commit myself to make WHO lead final efforts to eradicate poliomyelitis and to eliminate tetanus and dracucunliasis. WHO will launch new initiatives involving the scientific community in selecting for eradication those diseases that represent a high burden.

The Essential Drugs Policy adopted by the WHA in 1978 and the Action Program on Essential Drugs created the following year, are important tools for addressing these challenges. Despite progress made more work needs to be done to ensure greater access to life-saving pharmaceuticals in all parts of the world. We must, together with ALL concerned parties, review the experience of the past 25 years, the recent international agreements and the Doha Declaration, to better understand each others concerns and generate conditions for further innovation and success in this sensitive area.

Preventable Diseases: A Burden to Humanity

The disease burden in the world is still high despite improvements in life expectancy and in the infant mortality rate in the last 50 years. Disparities in the distribution of the disease burden across social strata and regions are glaring. For a number of diseases, mainly communicable, we now have the knowledge and technological means to prevent them, but they still heavily contribute to the total burden of disease I commit myself to develop a dynamic special initiative, with the involvement of interested partners, to make measurable progress in reducing the incidence and prevalence of priority preventable diseases. HIV/AIDS pandemic threatens global security by its impact on governance in most affected countries. WHO must catalyze innovative mechanisms and investment in research and development of clinical interventions to effectively control this scourge. We must select those diseases that represent a high burden, but can be prevented or eradicated by known technologies. If these technologies have not yet been applied or are not yet affordable, we must work with committed stakeholders, to develop innovative and bold approaches to achieve cost-effective technical interventions.

Maternal, Newborn and Child Health

Maternal, newborn and child health are not only key MDG indicators but also in itself, the health of this group embodies the social values of justice and equity. Consequently, WHO must play a pivotal role together with other agencies and partners to change the current picture of mother and child health. In effect, worldwide 11 million women and children under five die every year unnecessarily. The causes of death are well known to us and we also possess the knowledge and technology to prevent and treat the ailments associate with the excessive morbidity and mortality of women and children. There has been positive progress in relation to child health as shown by the decline of overall under five mortality rate in developing countries from 105 in 1990 to 88/1000 live births in 2003; however much less has been achieved on the maternal and newborn mortality figures. In fact we are observing either a stagnation or even a reversal of these indicators as is documented in the African Region where maternal mortality ratio rose from 870 in 1990 to 1000/100,000 live births in 2001. This unacceptable neglect aggravated by the low status of women and profound inequities, warrants an effective and immediate action by governments unequivocally supported by the international community, and WHO in particular. It is high time to use lessons learned to deliver maternal, newborn and child health programs in an integrated manner and at all levels from the household and community up to the referral hospital; each level with its appropriate measures. Skilled attendance at delivery and prompt access to Emergency Obstetric Care (EmOC) as well as family planning are elements of paramount importance among the essential intervention packages to reverse the current status. These approaches should also and necessarily strengthen health systems capacity and address the social underlying causes of precarious mother and child health so as to improve the odds of success.

Behavioral Change and Health Promotion

Sufficient body of evidence exists in support of human behavioral variables and health effects. Healthy choices about nutrition, sexual behavior, tobacco and alcohol consumption, drug abuse and physical exercise, just to mention some, are at the core of WHO health promotion paradigm. I intend to strengthen Health Promotion Program of WHO and ensure that resources will be allocated to this critical program including research to deepen our understanding about behavior determinants. WHO shall strengthen its capacity to provide appropriate technical support to Member States in this area.

Environmental Issues as Determinants of Human Health

For the last 25 years, the importance of the environment as an essential determinant of Human Health has become increasingly obvious. After the Rio Conference in 1992, a WHO special commission collected the evidence available at the time. The Johannesburg Summit reemphasized the relationship of Environment, Sustainable Development and Human Health. Vector borne diseases and those originated from unsafe water consumption, lack or inadequate sanitation and hygiene; deserve special attention particularly in poor settings of less developed countries. Increasing and unplanned urbanization in developing countries is a cause of concern to the health of urban dwellers. Repeated and systematic outbreaks of cholera, diarrheal diseases, meningitis, respiratory infections and the epidemic of traffic accidents in many crowded cities around the world illustrate the impact of human surroundings on their own health. WHO shall together with other UN partners and researchers seek innovative and effective ways to support member countries to develop and enforce healthy environmental regulatory and management frameworks.

Ageing: A Challenge for Health Systems

In the last three decades, there has been a growing acknowledgement that ageing constitutes a challenge for modern Health Systems. The problem, which was initially restricted to the developed industrialized countries, has now become of concern to an increasing number of countries and will very soon become a global concern. WHO has taken initiatives to help countries focus on this critical issue. WHO will play a leading role in expanding these efforts together with other partners.

Natural and Man Made Disasters as Barriers to Health

Famines, droughts, floods, mass movements of population and situations of conflict and war, as well as the threat of terrorism, are examples of potential health hazards to human populations as well as political and developmental disasters. Continuous and improved monitoring of health conditions by WHO and governments can provide early warning of impending disasters and or its consequences. Recent natural disasters such as tsunamis and major hurricanes, confirmed the importance of preventive and coordinated efforts against health consequences of natural disasters. I reiterate my commitment to improve WHO functionality to better support health operations in natural disasters to protect human health.

WHO will need to become more active in raising awareness of the health impacts of these events and assure that appropriate health action is included in international strategies to prevent and respond to these threats. In response to disasters, WHO should continue to improve its preparedness capacity and coordination with other agencies for rapid intervention with a minimum of bureaucratic delays. WHO is also in a unique position to affirm the value of human life and Health across the lines of conflict.