Speech by Dr. Brundtland at the WORLD BANK
     ___________________________________________
     Dr. Gro Harlem Brundtland
     The World Bank
     March 18, 1998
     _____________________________________________

General opening remarks

Thank you for inviting me here today. I welcome this opportunity of
meeting with you and listening to your views and suggestions.

Before I say anything else, let me just remind you that I do so in my
personal capacity.

It is often said, "where you stand depends on where you sit". At this
moment I happen to be between chairs.  I have been nominated to be the
next Director General of the World Health Organization. The election
will take place at the World Health Assembly  May and the
taking of office takes place in July.

It is a balancing act. In Norway, it is like the new fad among kids of
trying to ski with only one ski. Adults who try to do it fall down more
often.

So this is not the time to make detailed statements on priorities and
directions. However, I look forward to listening, and to learn, and
to share with you some of my thinking on the challenges ahead for world
health. They are many. They are crucial and we need to face them.

I had the opportunity of discussing some of these challenges when I met
with President Wolfensohn yesterday. As always I appreciate his
commitment, his vision and his readiness to look beyond the standard
answers. And I appreciate the opportunity I had this morning to meet
with the staff of the Health Nutrition and Population program.
     I strongly welcome the World Bank's involvement in health. The
joint effort of the international community would simply be incomplete
if the Bank did not get involved. I welcome the way in which health and
social issues figure more prominently in the way the bank sets its
priorities. And you can be assured that WHO will be there as an advocate
for health - providing input, setting standards and sometimes serving as
a reminder.

We need to be innovative and we need to work together. We need to
unleash resources - intellectual, political and financial. We cannot
allow health to remain a secondary item on the international political
agenda.

Health is pivotal. Health is the core of human development. Securing
that prominent role for health is a challenge to us all. It will require
a stronger partnership. I believe everyone in this room is committed to
that.

And moving health up the political agenda will require a respected
leading agency. And, that agency is the World Health Organization.
I am often asked; Are you a doctor or a politician? I am both, and I
think it has been a good combination when addressing problems and
finding solutions.

As a doctor and as a politician you have to ask: What is the problem?
What is the symptom? How can we prevent and cure? In short: What needs
to be done, who needs to be involved and how should we act together to
reach common goals?

Doctors fail if they only treat symptoms. So do international
organizations.

We must ask what is the cause, and how can we prevent and cure? And let
us keep the focus of our combined efforts the total health      outcome.
I believe it is a sound reminder to say that the test of what we do is
on the ground.  Poverty, uncontrolled disease, war,    environmental
impacts, tobacco - they are all enemies of health.

We know that the vast majority of human suffering and early deaths in
the world are poverty-related. Malnutrition has long been recognized as
a consequence of poverty. It is increasingly clear that it is also a
cause. Ill-health leads to poverty - and poverty  breeds ill-health.
People in developing countries carry 90 per cent of the disease burden,
yet have access to only 10 per cent of the resources used for    health.
This is unnecessary and other countries also suffer from the impact.

So in our quest for health we need to struggle against underdevelopment
and poverty. There is a danger that the health gaps which already exist
between the rich and the poor will widen. It is the narrowing of gaps -
between states as well as within states which must be our goal.

The task of reducing poverty is proving to be a long and difficult one.
I believe that targeted strategies emphasizing health investments in the
poor countries could significantly shorten the time it will take to
dramatically reduce the world's crushing bur den of poverty. This
message is what we need to bring to Prime Ministers and Finance
Ministers and to the entire civil society.

As a lead agency in health WHO faces many challenges. I will do what I
can to help the organization live up to its expectations. To set
clear priorities. Let me take this opportunity to mention one area of
concern which I believe has to be addressed swiftly. Malaria is on the
move again, wrecking lives and ruining economies. 90 per cent of deaths
from Malaria occur in Africa, but the Americas,  Asia and Europe are
also hit. In Africa it is estimated to cost ten working days of pay to
treat a case of Malaria. I is important to have a job. But you can't
work if you are sick.

When I met with the Executive Board of WHO I paid particular  attention
to Malaria. We thought it was declining. Some decades ago people even
thought we were heading for eradication. But now we are facing a disease
on the offensive. At the same time we ha the     knowledge to make a
real difference.
At the seminar on vaccination yesterday we heard new indications that
industry is getting closer to develop a reliable Malaria vaccine.
Malaria is on the agenda of African leaders.
G8 is ready to focus of Malaria. The World Bank is doing important work
with Africa on Malaria.
A number of UN agencies are involved in different capacities.

So time has come to mobilize and organize knowledge as well as resources
and to say the following:  If the World wants to fight poverty and
promote economic development in Africa, we must be serious about the
fight against this disease. We can roll back Malaria!

I have stated to the Executive Board of WHO that as the lead agency in
health, WHO should be the leader in a concerted global effort
against Malaria. To do this we need a new approach in the way we work
with other agencies; in the way our programs collaboratate; in the way
we communicate; in the way we build capacity on the ground. And, in the
way we raise funds and provide countries with the critical starting
resources for their renewed efforts. Then we must help them sustain
their efforts.

We need to work on a revised strategy to combat Malaria - a strategy to
ensure ownership by the health sector at a national and local   level,
especially in Africa - to improve the quality of all health services
with Malaria-control and prevention as an in tergral part. A strategy
which recognizes the need for new tools and involves the scientific
community and the private sector.

I had positive discussions with Jim Wolfensohn and Carol Bellamy of
UNICEF on this yesterday and I am confident that we can launch this
initiative. We must show the world that agencies can work better
together. We can do that - WHO, the World Bank, the other  UN
agencies, industry and NGO's can do that.

And let me add - because sometimes people ask if this emphasis on
Malaria means that other diseases such as HIV/AIDS and TB are less
important. My answer is clearly no. If we succeed in working in a new
and different way on a broad Malaria effort, then a other efforts will
benefit.

If we succeed in building better health systems - better health
infrastructure - if we succeed in better advocacy and better involvement
of civil society - then our efforts to support combat against other
major diseases will benefit.
We now know the daunting consequences of the HIV/AIDS epidemic,
especially in large parts of the developing world. We can and should
hope for breakthroughs in field of drugs and vaccination. But capacity
building and advocacy are keys to any progress.

WHO and the World Bank - each with their own mandates - are helping
countries to improve their health care delivery capacity. It is not
enough to have the vaccine. There have to be trained workers to get it
to the target population.  There must be a sustain able system for
financing of services, with a solid public sector commitment as the
foundation.

Capacity building in countries in greatest need must be a priority issue
for the international community. That is why I have stated my ambition
of introducing health sector development as a dimension in all WHO
programs.

Building a healthy economy is the most direct road toward ensuring a
healthy people. The fundamental cure is economic and social
development. It is the empowerment of people, both women and men. It is
in this overall framework that we shall place our comb for global
health. It is not a separate task.

There are important lessons to be learned from the way structural
adjustment programs have devised and carried through. There are
successes and failures and we can learn from both. You can expect WHO to
be there with its advice on sector wide reform - speaking  out for the
need to safeguard the role of health and social services. But that
message will not only go to the Bank and other financial institutions.
It must also reach the governments. They too have to make the right
priorities.

Health has no real quid pro quo. It is not a question of  "Its my money,
so do it my way." Health has no border. Few issues illustrate  the
global interdependence better.

Jim Wolfensohn said yesterday that too often health ministers were
absent from the meetings he had with governments. That, he said, has to
change. I agree. But I would add that we also have to remind Presidents,
Prime Ministers and Finance Ministers, that they are truly health
ministers themselves. Their overall decisions are decisive for the well
being of their people.

I believe that WHO as a leading advocate of health can set the agenda
around the world. But then we need to provide the evidence   that health
is key. Not only as a moral obligation - an ethical obligation - as a
human right. But also because it is pure an sound   economics.

A decade ago it became widely accepted that education, especially of
young women, was crucial for development. It still is. But now we have
new evidence of the role of health.

Most of the economists here at the Bank know it. And, Finance ministers
around the world should know it - and we need to remind  them, and be
able to back our statements up with facts. What we need is
evidence-based health policy.  What we need is the scie ific
underpinning of policy.

We need to get our statistics right and we need to allocate resources to
this neglected area. We need to know the burden of disease and define
our priorities accordingly. We will work together to make the case and
collect the facts. In the future WHO will have the relationship between
health, health policies and economic development as an underpinning of
its programs and selection of priorities.

There is no clearer example of a health program building better lives
than that of the topic of our discussions yesterday at the seminar on
vaccination. We can agree that immunization is among the most
cost-effective tools in illness prevention, and the most successful
global health program. And, I am committed to working with those
partners present at that meeting to bring existing and new vaccines to
the countries where they are needed.  This includes working with the
leaders of those companies that produce vaccines. Together we must
forward research and development.

Since the 1970ies we have come far - bringing immunization to a high
percentage of this world's children. Now we stand before a shift of
paradigm at the doorstep to major technological breakthroughs. It will
require a new and different kind of partnership And you can count on WHO
being there to help bring it forward.

But then again we must focus on advocacy and awareness raising -
bringing the evidence to the attention of the decision makers.
Political leaders have to be told - face to face - that immunization is
effective; that health care workers to administer it are crucial; and,
that building a primary care delivery system is their responsibility. We
cannot do it for them, but we have the tools to help and are eager to be
their partners.

In conclusion, let me say some words about reform.
In my speech before the Executive Board of WHO  this January I said it
was important that WHO commands respect in all countries. When there is
mutual trust, we can go to the capitals of major donor countries with a
convincing case.
To me reform is a positive, dynamic and exiting notion.
A well managed, efficient and transparent organization will have the
clout to address financial issues and attract additional resources.
Reform is about improving the way WHO manages its human and financial
resources.

I also said that WHO can do very little alone. It must set the global
health agenda, but to succeed it must welcome partners and work with
them.

My life has been devoted to finding the cause and seeking the cure, both
as a public health doctor and a political leader. I continue with that
philosophy and look forward to building a healthier future for the
people of the world with you as a partner.

Thank you.
Dr. Gro Harlem Brundtland

Forwarded from a message sent by
Leonard J. Duhl, MD
Professor of Public Health and Urban Planning,
University of California at Berkeley, 94720-7360
Phone: 510 642-1715   Fax: 510 643-6981   E-Mail:
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